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1. Sex differences in ischemic stroke during COVID-19 first outbreak in northern Italy

Author: Sangalli, D, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Canella, S, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Martinelli-Boneschi, F, Salmaggi, A, Sangalli D., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Canella S., Zanferrari C., Grampa G., d'Adda E., Peverelli L., Colombo A., Martinelli-Boneschi F., Salmaggi A., Sangalli, D, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Canella, S, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Martinelli-Boneschi, F, Salmaggi, A, Sangalli D., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Canella S., Zanferrari C., Grampa G., d'Adda E., Peverelli L., Colombo A., Martinelli-Boneschi F., and Salmaggi A.
Abstract: Introduction: COVID-19 pandemic had a great impact on outcome in SARS-CoV-2 positive patients with ischemic stroke during the first wave in Italy. Few data are available on outcome stratified by sex. Methods: The Italian Society of Hospital Neuroscience conducted a multi-center, retrospective, observational study on neurological complications in COVID-19 patients with ischemic stroke. All the patients admitted from March 1st to April 30th, 2020 in 20 Neurology Units in Northern Italy were recruited. Demographical and clinical features, treatment and outcome data were compared focusing on sex differences. Results: 812 patients with ischemic stroke were enrolled, of whom 129 with COVID-19; males were 53.8%. In-hospital mortality in COVID-19 patients was 35.3% in males and 27.9% in females while 8.5% in male and 5.8% in female patients without COVID-19. SARS-CoV-2 positive patients had a higher frequency of stroke of undetermined etiology, than negative ones (32.8% vs 22.5%; p = 0.02), especially in females compared to males (36.1% vs 27.9%), albeit without statistical significance. Male patients with SARS-CoV-2 were more likely to require cPAP (30.9% vs 14.8%; p = 0.03), endotracheal tube (14.9% vs 3.3%; p = 0.02) and reperfusion strategies (29.4% vs 11.5%; p = 0.01) than females, as well as to have a higher CRP and D-dimer. These elements together with older age, a total anterior circulation stroke and lymphopenia were predictors of a worse outcome. Discussion: Our study detected some differences due to sex in ischemic stroke with and without COVID-19, supporting the possibility to perform sex analyses for SARS-CoV-2 positive patients for a better clinical management.
Published: 2023

2. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19

Author: Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., Michel P., Marto, J, Strambo, D, Ntaios, G, Nguyen, T, Herzig, R, Czlonkowska, A, Demeestere, J, Mansour, O, Salerno, A, Wegener, S, Baumgartner, P, Cereda, C, Bianco, G, Beyeler, M, Arnold, M, Carrera, E, Machi, P, Altersberger, V, Bonati, L, Gensicke, H, Bolognese, M, Peters, N, Wetzel, S, Magrico, M, Ramos, J, Sargento-Freitas, J, Machado, R, Maia, C, Machado, E, Nunes, A, Ferreira, P, Pinho E Melo, T, Dias, M, Paula, A, Correia, M, Castro, P, Azevedo, E, Albuquerque, L, Alves, J, Ferreira-Pinto, J, Meira, T, Pereira, L, Rodrigues, M, Araujo, A, Rocha, M, Pereira-Fonseca, A, Ribeiro, L, Varela, R, Malheiro, S, Cappellari, M, Zivelonghi, C, Sajeva, G, Zini, A, Gentile, M, Forlivesi, S, Migliaccio, L, Sessa, M, La Gioia, S, Pezzini, A, Sangalli, D, Zedde, M, Pascarella, R, Ferrarese, C, Beretta, S, Diamanti, S, Schwarz, G, Frisullo, G, Marcheselli, S, Seners, P, Sabben, C, Escalard, S, Piotin, M, Maier, B, Charbonnier, G, Vuillier, F, Legris, L, Cuisenier, P, Vodret, F, Marnat, G, Liegey, J, Sibon, I, Flottmann, F, Broocks, G, Gloyer, N, Bohmann, F, Schaefer, J, Nolte, C, Audebert, H, Siebert, E, Sykora, M, Lang, W, Ferrari, J, Mayer-Suess, L, Knoflach, M, Gizewski, E, Stolp, J, Stolze, L, Coutinho, J, Nederkoorn, P, Van Den Wijngaard, I, De Meris, J, Lemmens, R, De Raedt, S, Vandervorst, F, Rutgers, M, Guilmot, A, Dusart, A, Bellante, F, Calleja-Castano, P, Ostos, F, Gonzalez-Ortega, G, Martin-Jimenez, P, Garcia-Madrona, S, Cruz-Culebras, A, Vera, R, Matute, M, Fuentes, B, Alonso-De-Lecinana, M, Rigual, R, Diez-Tejedor, E, Perez-Sanchez, S, Montaner, J, Diaz-Otero, F, Perez-De-La-Ossa, N, Flores-Pina, B, Munoz-Narbona, L, Chamorro, A, Rodriguez-Vazquez, A, Renu, A, Ayo-Martin, O, Hernandez-Fernandez, F, Segura, T, Tejada-Meza, H, Sagarra-Mur, D, Serrano-Ponz, M, Hlaing, T, See, I, Simister, R, Werring, D, Kristoffersen, E, Nordanstig, A, Jood, K, Rentzos, A, Simunek, L, Krajickova, D, Krajina, A, Mikulik, R, Cvikova, M, Vinklarek, J, Skoloudik, D, Roubec, M, Hurtikova, E, Hruby, R, Ostry, S, Skoda, O, Pernicka, M, Jurak, L, Eichlova, Z, Jira, M, Kovar, M, Pansky, M, Mencl, P, Palouskova, H, Tomek, A, Jansky, P, Olserova, A, Sramek, M, Havlicek, R, Maly, P, Trakal, L, Fiksa, J, Slovak, M, Karlinski, M, Nowak, M, Sienkiewicz-Jarosz, H, Bochynska, A, Wrona, P, Homa, T, Sawczynska, K, Slowik, A, Wlodarczyk, E, Wiacek, M, Tomaszewska-Lampart, I, Sieczkowski, B, Bartosik-Psujek, H, Bilik, M, Bandzarewicz, A, Dorobek, M, Zielinska-Turek, J, Nowakowska-Kotas, M, Obara, K, Urbanowski, P, Budrewicz, S, Guzinski, M, Switonska, M, Rutkowska, I, Sobieszak-Skura, P, Labuz-Roszak, B, Debiec, A, Staszewski, J, Stepien, A, Zwiernik, J, Wasilewski, G, Tiu, C, Terecoasa, E, Radu, R, Negrila, A, Dorobat, B, Panea, C, Tiu, V, Petrescu, S, Ozdemir, A, Mahmoud, M, El-Samahy, H, Abdelkhalek, H, Al-Hashel, J, Ismail, I, Salmeen, A, Ghoreishi, A, Sabetay, S, Gross, H, Klein, P, Abdalkader, M, Jabbour, P, El Naamani, K, Tjoumakaris, S, Abbas, R, Mohamed, G, Chebl, A, Min, J, Hovingh, M, Tsai, J, Khan, M, Nalleballe, K, Onteddu, S, Masoud, H, Michael, M, Kaur, N, Maali, L, Abraham, M, Khandelwal, P, Bach, I, Ong, M, Babici, D, Khawaja, A, Hakemi, M, Rajamani, K, Cano-Nigenda, V, Arauz, A, Amaya, P, Llanos, N, Arango, A, Vences, M, Barrientos Guerra, J, Caetano, R, Martins, R, Scollo, S, Yalung, P, Nagendra, S, Gaikwad, A, Seo, K, Georgiopoulos, G, Nogueira, R, Michel, P, Marto J. P., Strambo D., Ntaios G., Nguyen T. N., Herzig R., Czlonkowska A., Demeestere J., Mansour O. Y., Salerno A., Wegener S., Baumgartner P., Cereda C. W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magrico M., Ramos J. N., Sargento-Freitas J., Machado R., Maia C., Machado E., Nunes A. P., Ferreira P., Pinho E Melo T., Dias M. C., Paula A., Correia M. A., Castro P., Azevedo E., Albuquerque L., Alves J. N., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araujo A. P., Rocha M., Pereira-Fonseca A., Ribeiro L., Varela R., Malheiro S., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., La Gioia S., Pezzini A., Sangalli D., Zedde M., Pascarella R., Ferrarese C., Beretta S., Diamanti S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F. R., Marnat G., Liegey J. -S., Sibon I., Flottmann F., Broocks G., Gloyer N. -O., Bohmann F. O., Schaefer J. H., Nolte C., Audebert H. J., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E. R., Stolp J., Stolze L. J., Coutinho J. M., Nederkoorn P., Van Den Wijngaard I., De Meris J., Lemmens R., De Raedt S., Vandervorst F., Rutgers M. P., Guilmot A., Dusart A., Bellante F., Calleja-Castano P., Ostos F., Gonzalez-Ortega G., Martin-Jimenez P., Garcia-Madrona S., Cruz-Culebras A., Vera R., Matute M. C., Fuentes B., Alonso-De-Lecinana M., Rigual R., Diez-Tejedor E., Perez-Sanchez S., Montaner J., Diaz-Otero F., Perez-De-La-Ossa N., Flores-Pina B., Munoz-Narbona L., Chamorro A., Rodriguez-Vazquez A., Renu A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Sagarra-Mur D., Serrano-Ponz M., Hlaing T., See I., Simister R., Werring D., Kristoffersen E. S., Nordanstig A., Jood K., Rentzos A., Simunek L., Krajickova D., Krajina A., Mikulik R., Cvikova M., Vinklarek J., Skoloudik D., Roubec M., Hurtikova E., Hruby R., Ostry S., Skoda O., Pernicka M., Jurak L., Eichlova Z., Jira M., Kovar M., Pansky M., Mencl P., Palouskova H., Tomek A., Jansky P., Olserova A., Sramek M., Havlicek R., Maly P., Trakal L., Fiksa J., Slovak M., Karlinski M. A., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiacek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielinska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guzinski M., Switonska M., Rutkowska I., Sobieszak-Skura P., Labuz-Roszak B. M., Debiec A., Staszewski J., Stepien A., Zwiernik J., Wasilewski G., Tiu C., Terecoasa E. O., Radu R. A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Ozdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ismail I. I., Salmeen A., Ghoreishi A., Sabetay S. I., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G. A., Chebl A., Min J., Hovingh M., Tsai J. P., Khan M., Nalleballe K., Onteddu S., Masoud H., Michael M., Kaur N., Maali L., Abraham M. G., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A. M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M. A., Barrientos Guerra J. D., Caetano R., Martins R. T., Scollo S. D., Yalung P. M., Nagendra S., Gaikwad A., Seo K. -D., Georgiopoulos G., Nogueira R. G., and Michel P.
Abstract: Background and Objectives COVID-19–related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. Methods This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Results Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour mortality (OR 2.47; 95% CI 1.58–3.86), and 3-month mortality (OR 1.88; 95% CI 1.52–2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60). Discussion Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non–COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment r
Published: 2023

3. SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy

Author: Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Diamanti, S, Santangelo, F, Xhani, R, Pozzi, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Diamanti S., Santangelo F., Xhani R., Pozzi F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., Padovani A., Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Diamanti, S, Santangelo, F, Xhani, R, Pozzi, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Diamanti S., Santangelo F., Xhani R., Pozzi F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., and Padovani A.
Abstract: Objective: To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients. Methods: In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19. Results: Among 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06–2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05–2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17–5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death. Conclusions: Ischemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase.
Published: 2022

4. A snapshot of emergency neurology management in the Lombardy Region, Italy

Author: Zanferrari, C, Salmaggi, A, Belcastro, V, Domina, E, Beretta, S, Braga, M, Bonato, S, Ghione, I, Caputi, L, Brusaferri, F, Cavallini, A, Persico, A, Ciccone, A, Silvestrelli, G, Clerici, R, De Piazza, C, Conti, G, Cotelli, M, Turla, M, Dallocchio, C, Mazza, S, Ferrarese, C, Piatti, M, Ferraro, B, Carpo, M, Fanucchi, S, Fiacco, F, Maggio, P, Frediani, F, Tonietti, S, Grampa, G, Russo, L, Savio, F, Magni, E, Palmerini, F, Magoni, M, Marcheselli, S, Corato, M, Mattioli, M, Padovani, A, Pantoni, L, Baso, G, Prelle, A, Muscia, F, Priori, A, Tancredi, L, Santilli, I, Scaccabarozzi, C, Sessa, M, Gioia, S, Zanferrari C., Salmaggi A., Belcastro V., Domina E., Beretta S., Braga M., Bonato S., Ghione I., Caputi L., Brusaferri F., Cavallini A., Persico A., Ciccone A., Silvestrelli G., Clerici R., De Piazza C., Conti G., Cotelli M. S., Turla M., Dallocchio C., Mazza S., Ferrarese C., Piatti M. L., Ferraro B., Carpo M., Fanucchi S., Fiacco F., Maggio P., Frediani F., Tonietti S., Grampa G., Russo L. L., Savio F. L., Magni E., Palmerini F., Magoni M., Marcheselli S., Corato M., Mattioli M., Padovani A., Pantoni L., Baso G., Prelle A., Muscia F., Priori A., Tancredi L., Santilli I., Scaccabarozzi C., Sessa M., Gioia S. L., Zanferrari, C, Salmaggi, A, Belcastro, V, Domina, E, Beretta, S, Braga, M, Bonato, S, Ghione, I, Caputi, L, Brusaferri, F, Cavallini, A, Persico, A, Ciccone, A, Silvestrelli, G, Clerici, R, De Piazza, C, Conti, G, Cotelli, M, Turla, M, Dallocchio, C, Mazza, S, Ferrarese, C, Piatti, M, Ferraro, B, Carpo, M, Fanucchi, S, Fiacco, F, Maggio, P, Frediani, F, Tonietti, S, Grampa, G, Russo, L, Savio, F, Magni, E, Palmerini, F, Magoni, M, Marcheselli, S, Corato, M, Mattioli, M, Padovani, A, Pantoni, L, Baso, G, Prelle, A, Muscia, F, Priori, A, Tancredi, L, Santilli, I, Scaccabarozzi, C, Sessa, M, Gioia, S, Zanferrari C., Salmaggi A., Belcastro V., Domina E., Beretta S., Braga M., Bonato S., Ghione I., Caputi L., Brusaferri F., Cavallini A., Persico A., Ciccone A., Silvestrelli G., Clerici R., De Piazza C., Conti G., Cotelli M. S., Turla M., Dallocchio C., Mazza S., Ferrarese C., Piatti M. L., Ferraro B., Carpo M., Fanucchi S., Fiacco F., Maggio P., Frediani F., Tonietti S., Grampa G., Russo L. L., Savio F. L., Magni E., Palmerini F., Magoni M., Marcheselli S., Corato M., Mattioli M., Padovani A., Pantoni L., Baso G., Prelle A., Muscia F., Priori A., Tancredi L., Santilli I., Scaccabarozzi C., Sessa M., and Gioia S. L.
Abstract: Background: The assessment of human and diagnostic resources is a prerequisite to improving the management of emergency neurology. Objective: To provide a landscape on the organization of the Lombardy Region hospitals for emergency neurological care management. Methods: We designed an anonymized questionnaire including 6 sections with 21 questions on facilities, human and diagnostic resources, and intra- and between-hospital connections. The time needed to fill the questionnaire was estimated not to exceed 6 min. Results: The questionnaire was returned by 33/41 (80.5%) hospitals, 22 classified as level 1 (spoke), and 11 as level 2 (hub). Five of 33 (15%) did not have a neurology unit. The mean annual rate of neurological consultations accounted for 5–6% of all admissions (range 2–8%) and did not differ between levels 1 and 2 hospitals. Neurologists were 24-h available in 21/33 (64%) hospitals, 12-h and on call at night in 6 (18%), less than 12 h without nocturnal availability in 5 (15%), and neither present nor available in 1 (3%). Brain CT and CSF examinations were 24-h universally available, whereas EEG and neurosonology were not in most hospitals. Despite angio-CT was 24-h available in more than 75% of the hospitals, only 45% of them had 24-h availability of diffusion/perfusion imaging, and 43% were not available at any time. Only 12% of the hospitals had 24-h availability of neuroradiologists and 6% of interventional neuroradiologists. Conclusion: Our data, while emphasizing current critical issues, offer clues for identifying priorities and improving the management of emergency and time-dependent neurological diseases.
Published: 2022

5. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke

Author: Gentile, L, Pracucci, G, Saia, V, Falcou, A, Biraschi, F, Zini, A, Simonetti, L, Riva, L, Bigliardi, G, Vallone, S, Nencini, P, Limbucci, N, Diomedi, M, Da Ros, V, Longoni, M, Ruggiero, M, Tassinari, T, Allegretti, L, Cerrato, P, Rubino, E, Bergui, M, Cavallo, R, Naldi, A, Comelli, C, Cappellari, M, Zivelonghi, C, Plebani, M, De Vito, A, Merli, N, Saletti, A, Musolino, Rf, Ferraù, L, Vinci, Sl, Sacco, S, Orlandi, B, De Santis, F, Filauri, P, Ruiz, L, Sepe, Fn, Gallesio, I, Petruzzellis, M, Chiumarulo, L, Sangalli, D, Salmaggi, A, Filizzolo, M, Moller, J, Melis, M, Comelli, S, Magoni, M, Gilberti, N, Gasparotti, R, Invernizzi, P, Pavia, M, Pinto, V, Laspada, S, Marcheselli, S, Ajello, D, Viaro, F, Baracchini, C, Causin, F, Giannini, N, Caselli, Mc, Mancuso, M, Cosottini, M, Scoditti, U, Menozzi, R, Russo, M, Amistá, P, Napoletano, R, Romano, Dg, Tassi, R, Bracco, S, Carimati, F, Versino, M, Giorgianni, A, De Boni, A, Fasano, A, Barbarini, L, Paladini, A, Franchini, E, Dall'Ora, E, Comai, A, Giovanni, F, Pedicelli, A, Sallustio, F, Casetta, I, Fainardi, E, Mangiafico, S, and Toni, D
Subjects: Left ventricular ejection fraction, Acute ischemic stroke, Heart failure, Mechanical thrombectomy, Settore MED/37 - Neuroradiologia, Settore MED/26
Published: 2023

6. Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy

Author: Sangalli, D, Martinelli-Boneschi, F, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Altavilla, R, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Santalucia, P, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Salmaggi, A, Sangalli D., Martinelli-Boneschi F., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Altavilla R., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Santalucia P., Zanferrari C., Grampa G., D'Adda E., Peverelli L., Colombo A., Salmaggi A., Sangalli, D, Martinelli-Boneschi, F, Versino, M, Colombo, I, Ciccone, A, Beretta, S, Marcheselli, S, Altavilla, R, Roncoroni, M, Lorusso, L, Cavallini, A, Prelle, A, Guidetti, D, La Gioia, S, Santalucia, P, Zanferrari, C, Grampa, G, D'Adda, E, Peverelli, L, Colombo, A, Salmaggi, A, Sangalli D., Martinelli-Boneschi F., Versino M., Colombo I., Ciccone A., Beretta S., Marcheselli S., Altavilla R., Roncoroni M., Lorusso L., Cavallini A., Prelle A., Guidetti D., La Gioia S., Santalucia P., Zanferrari C., Grampa G., D'Adda E., Peverelli L., Colombo A., and Salmaggi A.
Abstract: Introduction: Growing evidence has been published as to the impact of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) on cerebrovascular events over the last few months, with considerable attention paid to ischemic strokes. Conversely, little is known about the clinical course of intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection. Method: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurological Departments in Northern Italy. Clinical data on patients with acute cerebrovascular diseases, admitted from March 1st to April 30th, 2020, were collected. A comparison was made of the demographical and clinical features of both SARS-CoV-2 positive and negative patients with ICH. Results: 949 patients were enrolled (average age 73.4 years; 52.7% males); 135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, both symptomatic and asymptomatic. SARS-CoV-2 related pneumonia or respiratory distress (OR 5.4), lobar location (OR 5.0) and previous antiplatelet or anticoagulant treatment (OR 2.9) were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a non-significantly increased risk of in-hospital death (37.5% vs 23.4%, p = 0.2). Discussion: ICH patients with COVID-19 did not experience an increase in mortality as striking as ischemic stroke. The inflammatory response and respiratory complications could justify the slight increase of death in ICH. Bleeding sites and previous antiplatelet or anticoagulant treatment were the only other predictors of a worse outcome.
Published: 2021

7. Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network

Author: Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Xhani, R, Pozzi, F, Diamanti, S, Santangelo, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Xhani R., Pozzi F., Diamanti S., Santangelo F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., Padovani A., Pezzini, A, Grassi, M, Silvestrelli, G, Locatelli, M, Rifino, N, Beretta, S, Gamba, M, Raimondi, E, Giussani, G, Carimati, F, Sangalli, D, Corato, M, Gerevini, S, Masciocchi, S, Cortinovis, M, La Gioia, S, Barbieri, F, Mazzoleni, V, Pezzini, D, Bonacina, S, Pilotto, A, Benussi, A, Magoni, M, Premi, E, Prelle, A, Agostoni, E, Palluzzi, F, De Giuli, V, Magherini, A, Roccatagliata, D, Vinciguerra, L, Puglisi, V, Fusi, L, Xhani, R, Pozzi, F, Diamanti, S, Santangelo, F, Grampa, G, Versino, M, Salmaggi, A, Marcheselli, S, Cavallini, A, Giossi, A, Censori, B, Ferrarese, C, Ciccone, A, Sessa, M, Padovani, A, Pezzini A., Grassi M., Silvestrelli G., Locatelli M., Rifino N., Beretta S., Gamba M., Raimondi E., Giussani G., Carimati F., Sangalli D., Corato M., Gerevini S., Masciocchi S., Cortinovis M., La Gioia S., Barbieri F., Mazzoleni V., Pezzini D., Bonacina S., Pilotto A., Benussi A., Magoni M., Premi E., Prelle A. C., Agostoni E. C., Palluzzi F., De Giuli V., Magherini A., Roccatagliata D. V., Vinciguerra L., Puglisi V., Fusi L., Xhani R., Pozzi F., Diamanti S., Santangelo F., Grampa G., Versino M., Salmaggi A., Marcheselli S., Cavallini A., Giossi A., Censori B., Ferrarese C., Ciccone A., Sessa M., and Padovani A.
Abstract: Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62–80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5–270) minutes vs. 190 (IQR 150–245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82–13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10–0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04–4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85–14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions.
Published: 2021

8. Computerised Guidelines Implementation: Obtaining Feedback for Revision of Guidelines, Clinical Data Model and Data Flow

Author: Panzarasa, S., Quaglini, S., Cavallini, A., Marcheselli, S., Stefanelli, M., Micieli, G., Carbonell, Jaime G., editor, Siekmann, Jörg, editor, Bellazzi, Riccardo, editor, Abu-Hanna, Ameen, editor, and Hunter, Jim, editor
Published: 2007
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9. Intracranial haemorrhage: the solution offered by recombinant factor VIIa

Author: Micieli, G., Cavallini, A., Marcheselli, S., and Gullo, Antonino, editor
Published: 2005
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10. Thrombolysis and bridging therapy in patients with acute ischaemic stroke and Covid-19

Author: Cappellari, M, Zini, A, Sangalli, D, Cavallini, A, Reggiani, M, Sepe, F, Rifino, N, Giussani, G, Guidetti, D, Zedde, M, Marcheselli, S, Longoni, M, Beretta, S, Sidoti, V, Papurello, D, Giossi, A, Nencini, P, Plocco, M, Balestrino, M, Rota, E, Toni, D, Cappellari M., Zini A., Sangalli D., Cavallini A., Reggiani M., Sepe F. N., Rifino N., Giussani G., Guidetti D., Zedde M., Marcheselli S., Longoni M., Beretta S., Sidoti V., Papurello D. M., Giossi A., Nencini P., Plocco M., Balestrino M., Rota E., Toni D., Cappellari, M, Zini, A, Sangalli, D, Cavallini, A, Reggiani, M, Sepe, F, Rifino, N, Giussani, G, Guidetti, D, Zedde, M, Marcheselli, S, Longoni, M, Beretta, S, Sidoti, V, Papurello, D, Giossi, A, Nencini, P, Plocco, M, Balestrino, M, Rota, E, Toni, D, Cappellari M., Zini A., Sangalli D., Cavallini A., Reggiani M., Sepe F. N., Rifino N., Giussani G., Guidetti D., Zedde M., Marcheselli S., Longoni M., Beretta S., Sidoti V., Papurello D. M., Giossi A., Nencini P., Plocco M., Balestrino M., Rota E., and Toni D.
Abstract: Background and purpose: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy). Methods: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT. Results: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. Conclusions: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre–Covid-19 literature. However, risk of sICH was not increased.
Published: 2020

11. Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults

Author: Poli, L., Zedde, M., Zini, A., Del Sette, M., Lodigiani, C., Spalloni, A., Di Lisi, F., Toriello, A., Piras, V., Stilo, C., Tomelleri, G., Tancredi, L., Paciaroni, M., Silvestrelli, G., Adami, A., Costa, P., Morotti, A., De Giuli, V., Caria, F., Gamba, M., Malferrari, G., Simone, A. M., Musolino, R., Giorli, E., Banfi, E., Marcheselli, S., Rasura, M., Pugliese, N., Melis, M., Bovi, P., Padovani, A., Burlina, A., Pezzini, A., Del Zotto, Elisabetta, Giossi, Alessia, Sessa, Maria, Gilberti, Nicola, Magoni, Mauro, Ferrazzi, Paola, Librè, Luca, Rota, Lidia Luciana, Patella, Rosalba, Di Liso, Filomena, Calabrò, Rocco Salvatore, Bramanti, Placido, La Spina, Paolo, Finocchi, Cinzia, Balestrino, Maurizio, Bruno, Chiara, Massucco, Davide, Gandolfo, Carlo, Traverso, Elisabetta, DeLodovici, Maria Luisa, Verrengia, Elena Pinuccia, Carimati, Federico, Bono, Giorgio, DellʼAcqua, Maria Luisa, Bigliardi, Guido, Vandelli, Laura, Nichelli, Paolo Frigio, Carletti, Monica, Cerrato, Paolo, Iacoviello, Licia, Di Castelnuovo, Augusto, de Gaetano, Giovanni, Grassi, Mario, Locatelli, Giampiero, Caso, Valeria, DʼAmore, Cataldo, Agnelli, Giancarlo, Checcarelli, Nicoletta, Guidotti, Mario, Arnaboldi, Marco, Giacalone, Giacomo, Zanoli, Elisa, Cavallini, Anna, Persico, Alessandra, Micieli, Giuseppe, Chiti, Alberto, Orlandi, Giovanni, Marchi, Piernicola, Lanari, Alessia, Ciccone, Alfonso, Cucurachi, Laura, Bonifati, Marco Domenico, and Marcello, Norina
Published: 2017
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12. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke

Author: Sallustio, Fabrizio, Pracucci, Giovanni, Cappellari, Manuel, Saia, Valentina, Mascolo, Alfredo Paolo, Marrama, Federico, Gandini, Roberto, Koch, Giacomo, Diomedi, Marina, D’Agostino, Federica, Rocco, Alessandro, Da Ros, Valerio, Wlderk, Andrea, Nezzo, Marco, Argirò, Renato, Morosetti, Daniele, Renieri, Leonardo, Nencini, Patrizia, Vallone, Stefano, Zini, Andrea, Bigliardi, Guido, Pitrone, Antonio, Grillo, Francesco, Bracco, Sandra, Tassi, Rossana, Bergui, Mauro, Naldi, Andrea, Carità, Giuseppe, Casetta, Ilaria, Gasparotti, Roberto, Magoni, Mauro, Simonetti, Luigi, Haznedari, Nicolò, Paolucci, Matteo, Mavilio, Nicola, Malfatto, Laura, Menozzi, Roberto, Genovese, Antonio, Cosottini, Mirco, Orlandi, Giovanni, Comai, Alessio, Franchini, Enrica, Pedicelli, Alessandro, Frisullo, Giovanni, Puglielli, Edoardo, Casalena, Alfonsina, Cester, Giacomo, Baracchini, Claudio, Castellano, Davide, Di Liberto, Alessandra, Ricciardi, Giuseppe Kenneth, Chiumarulo, Luigi, Petruzzellis, Marco, Lafe, Elvis, Persico, Alessandra, Cavasin, Nicola, Critelli, Adriana, Semeraro, Vittorio, Tinelli, Angelica, Giorgianni, Andrea, Carimati, Federico, Auteri, William, Rizzuto, Stefano, Biraschi, Francesco, Nicolini, Ettore, Ferrari, Antonio, Melis, Maurizio, Calia, Stefano, Tassinari, Tiziana, Nuzzi, Nunzio Paolo, Corato, Manuel, Sacco, Simona, Squassina, Guido, Invernizzi, Paolo, Gallesio, Ivan, Ruiz, Luigi, Dui, Giovanni, Carboni, Nicola, Amistà, Pietro, Russo, Monia, Maiore, Mario, Zanda, Bastianina, Craparo, Giuseppe, Mannino, Marina, Inzitari, Domenico, Toni, Danilo, Mangiafico, Salvatore, Gasparotti, R., Inzitari, D., Mangiafico, S., Toni, D., Vallone, S., Zini, A., Bergui, M., Causin, F., Ciccone, A., Nencini, P., Saletti, A., Sallustio, F., Tassi, R., Thyrion, F. Zappoli, Pracucci, G., Saia, V., Gandini, R., Da Ros, V., Greco, L., Morosetti, D., Diomedi, M., Nappini, S., Limbucci, N., Renieri, L., Fainardi, E., Verganti, L., Sacchetti, F., Zelent, G., Bigliardi, G., Dell’Acqua, M. L., Picchetto, L., Vandelli, L., Pentore, R., Maffei, S., Nichelli, P., Longo, M., Pitrone, A., Vinci, S. L., Velo, M., Caragliano, A., Tessitore, A., Bonomo, O., Musolino, R., La Spina, P., Casella, C., Fazio, M. C., Grillo, F., Cotroneo, M., Dell’Aera, C., Francalanza, I., Bracco, S., Cioni, S., Gennari, P., Vallone, I. M., Cerase, A., Martini, G., Stura, G., Daniele, D., Cerrato, P., Naldi, A., Onofrio, M., De Vito, A., Azzini, C., Casetta, I., Mardighian, D., Frigerio, M., Magoni, M., Costa, A., Simonetti, L., Cirillo, L., Taglialatela, F., Isceri, S., Princiotta, C., Dall’Olio, M., Cellerini, M., Gentile, M., Piccolo, L., Migliaccio, L., Brancaleoni, L., Naldi, F., Romoli, M., Zaniboni, A., Ruggiero, M., Sanna, A., Haznedari, N., Commodaro, C., Longoni, M., Biguzzi, S., Cordici, F., Malatesta, E., Castellan, L., Mavilio, N., Salsano, G., Malfatto, L., Finocchi, C., Menozzi, R., Piazza, P., Epifani, E., Andreone, A., Scoditti, U., Castellini, P., Latte, L., Grisendi, I., Cosottini, M., Puglioli, M., Lazzarotti, G., Lauretti, D., Mancuso, M., Giannini, N., Maccarone, M., Orlandi, G., Comai, A., Bonatti, G., Nano, G., Ferro, F., Bonatti, M., Dall’Ora, E., Dossi, R. Currò, Turri, E., Turri, M., Colosimo, C., Pedicelli, A., D’Argento, F., Alexandre, A., Frisullo, G., Di Egidio, V., Puglielli, E. G., Ruggero, L., Assetta, M., Casalena, A., Cester, G., Baracchini, C., Viaro, F., Pieroni, A., Vaudano, G., Comelli, C., Di Maggio, L., Castellano, D., Cavallo, R., Duc, E., Chianale, G., Ciceri, E. F. M., Plebani, M., Augelli, R., Zampieri, P., Grazioli, A., Cappellari, M., Forlivesi, S., Tomelleri, G., Micheletti, N., Chiumarulo, L., Zimatore, D. S., Federico, F., Petruzzelli, M., Zappoli, F., Lafe, E., Sanfilippo, G., Sgreccia, A., Martignoni, A., Cavallini, A., Denaro, F., Persico, A., Cagliari, E., Cavasin, N., Quatrale, R., Critelli, A., Burdi, N., Semeraro, V., Lucarelli, N., Ganimede, M. P., Internò, S., Tinelli, A., Prontera, M. P., Pesare, A., Cotroneo, E., Pampana, E., Ricciardi, F., Gigli, R., Pezzella, F. R., Corsi, F., Giorgianni, A., Baruzzi, F., Pellegrino, C., Terrana, A., Versino, M., Delodovici, M. L., Carimati, F., Cariddi, L. Princiotta, Auteri, W., Di Benedetto, O., Silvagni, U., Perrotta, P., Crispino, E., Petrone, A., Stancati, F., Rizzuto, S., Pugliese, P., Pisani, E., Siniscalchi, A., Gaudiano, C., Pirritano, D., Del Giudice, F., Piano, M., Agostoni, E., Motto, C., Gatti, A., Guccione, A., Tortorella, R., Stecco, A., Guzzardi, G., Del Sette, B., Coppo, L., Baldan, J., Romano, D., Siani, A., Locatelli, G., Saponiero, R., Napolitano, R., De Gregorio, M., Volpe, G., Tenuta, M., Guidetti, G., Biraschi, F., Wulbek, A., Falcou, A., Anzini, A., Mancini, A., De Michele, M., Fausti, S., Di Mascio, M. T., Durastanti, L., Sbardella, E., Mellina, V., Nicolini, E., Comelli, S., Ganau, C., Corraine, S., Fusaro, F., Ferrari, A., Schirru, F., Ledda, V., Secci, S., Melis, M., Piras, V., Moller, J., Padolecchia, R., Allegretti, L., Caldiera, V., Calia, S., Ganci, G., Tassinari, T., Sugo, A., De Nicola, M., Giannoni, M., Bruni, S., Gambelli, E., Provinciali, L., Nuzzi, N. P., Marcheselli, S., Corato, M., Scomazzoni, F., Simionato, F., Roveri, L., Filauri, P., Sacco, S., Orlandi, B., De Santis, F., Tiseo, C., Notturno, F., Ornello, R., Pavia, M., Squassina, G., Cobelli, M., Morassi, M., Magni, E., Invernizzi, P., Pepe, F., Bigni, B., Costa, P., Crabbio, M., Griffini, S., Palmerini, F., Piras, M. P., Gallesio, I., Barbero, S., Ferrandi, D., Dui, G., Fancello, M. C., Zedda, S., Ticca, A., Saddi, M. V., Deiana, G., Rossi, R., Carboni, N., Mela, A., Amistà, P., Russo, M., Iannucci, G., Pinna, V., Di Clemente, L., Santi, M., De Boni, A., De Luca, C., Natrella, M., Fanelli, G., Cristoferi, M., Bottacchi, E., Corso, G., Tosi, P., Sessa, M., Giossi, A., Baietti, Null, Romano, G., Meineri, P., Armentano, A., Versace, P., Arcudi, L., Galvano, G., Petralia, B., Feraco, P., Luppi, G., Giometto, B., Bignamini, V., Piffer, S., Meloni, G. B., Fabio, C., Maiore, M., Pintus, F., Pischedda, A., Manca, A., Mongili, C., Zanda, B., Baule, A., Florio, F., Ciccarese, G., Leone, M., Di Viesti, P., Pappalardo, M. P., Craparo, G., Gallo, C., Monaco, S., Mannino, M., Muto, M., Guarnieri, Gl., Andreone, V., Passalacqua, G., Allegritti, M., Caproni, S., Filizzolo, M., Salmaggi, A., Giordano, A., Marini, C., Frattale, I., Lucente, G., Nozzoli, C., and Lupo, F. A.
Subjects: Stent, Acute stroke, Settore MED/37 - Neuroradiologia, Acute stroke Internal carotid artery diseases Stent Thrombectomy, Neurology (clinical), General Medicine, Settore MED/26, Internal carotid artery diseases, Thrombectomy
Abstract: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively.Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.
Published: 2022

13. Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation

Author: Polymeris, A. A., Macha, K., Paciaroni, M., Wilson, D., Koga, M., Cappellari, M., Schaedelin, S., Zietz, A., Peters, N., Seiffge, D. J., Haupenthal, D., Gassmann, L., De Marchis, G. M., Wang, R., Gensicke, H., Stoll, S., Thilemann, S., Avramiotis, N. S., Bonetti, B., Tsivgoulis, G., Ambler, G., Alberti, A., Yoshimura, S., Brown, M. M., Shiozawa, M., Lip, G. Y. H., Venti, M., Acciarresi, M., Tanaka, K., Mosconi, M. G., Takagi, M., Jager, R. H., Muir, K., Inoue, M., Schwab, S., Bonati, L. H., Lyrer, P. A., Toyoda, K., Caso, V., Werring, D. J., Kallmunzer, B., Engelter, S. T., Traenka, C., Hert, L., Wagner, B., Schaub, F., Meya, L., Fladt, J., Dittrich, T., Fisch, U., Volbers, B., Siedler, G., Bovi, P., Tomelleri, G., Micheletti, N., Zivelonghi, C., Emiliani, A., Parry-Jones, A., Patterson, C., Price, C., Elmarimi, A., Parry, A., Nallasivam, A., Nor, A. M., Esis, B., Bruce, D., Bhaskaran, B., Roffe, C., Cullen, C., Holmes, C., Cohen, D., Hargroves, D., Mangion, D., Chadha, D., Vahidassr, D., Manawadu, D., Giallombardo, E., Warburton, E., Flossman, E., Gunathilagan, G., Proschel, H., Emsley, H., Anwar, I., Burger, I., Okwera, J., Putterill, J., O'Connell, J., Bamford, J., Corrigan, J., Scott, J., Birns, J., Kee, K., Saastamoinen, K., Pasco, K., Dani, K., Sekaran, L., Choy, L., Iveson, L., Mamun, M., Sajid, M., Cooper, M., Burn, M., Smith, M., Power, M., Davis, M., Smyth, N., Veltkamp, R., Sharma, P., Guyler, P., O'Mahony, P., Wilkinson, P., Datta, P., Aghoram, P., Marsh, R., Luder, R., Meenakishundaram, S., Subramonian, S., Leach, S., Ispoglou, S., Andole, S., England, T., Manoj, A., Harrington, F., Rehman, H., Sword, J., Staals, J., Mahawish, K., Harkness, K., Shaw, L., Mccormich, M., Sprigg, N., Mansoor, S., Krishnamurthy, V., Giustozzi, M., Agnelli, G., Becattini, C., D'Amore, C., Cimini, L. A., Bandini, F., Liantinioti, C., Chondrogianni, M., Yaghi, S., Furie, K. L., Tadi, P., Zedde, M., Abdul-Rahim, A. H., Lees, K. R., Carletti, M., Rigatelli, A., Putaala, J., Tomppo, L., Tatlisumak, T., Marcheselli, S., Pezzini, A., Poli, L., Padovani, A., Vannucchi, V., Masotti, L., Sohn, S. -I., Lorenzini, G., Tassi, R., Guideri, F., Acampa, M., Martini, G., Ntaios, G., Athanasakis, G., Makaritsis, K., Karagkiozi, E., Vadikolias, K., Mumoli, N., Galati, F., Sacco, S., Tiseo, C., Corea, F., Ageno, W., Bellesini, M., Colombo, G., Silvestrelli, G., Ciccone, A., Lanari, A., Scoditti, U., Denti, L., Mancuso, M., Maccarrone, M., Ulivi, L., Orlandi, G., Giannini, N., Tassinari, T., De Lodovici, M. L., Rueckert, C., Baldi, A., Toni, D., Letteri, F., Pieroni, A., Giuntini, M., Lotti, E. M., Flomin, Y., Kargiotis, O., Karapanayiotides, T., Monaco, S., Baronello, M. M., Csiba, L., Szabo, L., Chiti, A., Giorli, E., Del Sette, M., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Michel, P., Vanacker, P., Barlinn, K., Pallesen, L. -P., Barlinn, J., Deleu, D., Melikyan, G., Ibrahim, F., Akhtar, N., Gourbali, V., Todo, K., Kimura, K., Shibazaki, K., Yagita, Y., Furui, E., Itabashi, R., Terasaki, T., Shiokawa, Y., Hirano, T., Suzuki, R., Kamiyama, K., Nakagawara, J., Takizawa, S., Homma, K., Okuda, S., Okada, Y., Maeda, K., Kameda, T., Kario, K., Nagakane, Y., Hasegawa, Y., Akiyama, H., Shibuya, S., Mochizuki, H., Ito, Y., Nakashima, T., Matsuoka, H., Takamatsu, K., Nishiyama, K., Endo, K., Miyagi, T., Osaki, M., Kobayashi, J., Okata, T., Tanaka, E., Sakamoto, Y., Tokunaga, K., Takizawa, H., Takasugi, J., Matsubara, S., Higashida, K., Matsuki, T., Kinoshita, N., Ide, T., Yoshimoto, T., Ando, D., Fujita, K., Kumamoto, M., Kamimura, T., Kikuno, M., Mizoguchi, T., and Sato, T.
Subjects: Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, 610 Medicine & health, Aged, 80 and over, Atrial Fibrillation, Factor Xa Inhibitors, Female, Humans, Stroke, Continuous variable, Internal medicine, 80 and over, medicine, Aged, Proportional hazards model, business.industry, Anticoagulant, Confounding, Atrial fibrillation, Patient data, medicine.disease, Oldest old, Neurology, Neurology (clinical), 610 Medizin und Gesundheit, business
Abstract: Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR = 0.79, 95%-CI [0.66, 0.95]) in simple (p interaction = 0.129), adjusted (p interaction = 0.094) or weighted (p interaction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.
Published: 2022

14. Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Author: Polymeris, A.A. Macha, K. Paciaroni, M. Wilson, D. Koga, M. Cappellari, M. Schaedelin, S. Zietz, A. Peters, N. Seiffge, D.J. Haupenthal, D. Gassmann, L. De Marchis, G.M. Wang, R. Gensicke, H. Stoll, S. Thilemann, S. Avramiotis, N.S. Bonetti, B. Tsivgoulis, G. Ambler, G. Alberti, A. Yoshimura, S. Brown, M.M. Shiozawa, M. Lip, G.Y.H. Venti, M. Acciarresi, M. Tanaka, K. Mosconi, M.G. Takagi, M. Jäger, R.H. Muir, K. Inoue, M. Schwab, S. Bonati, L.H. Lyrer, P.A. Toyoda, K. Caso, V. Werring, D.J. Kallmünzer, B. Engelter, S.T. Engelter, S.T. Lyrer, P.A. Bonati, L.H. Seiffge, D.J. Traenka, C. Polymeris, A.A. Zietz, A. Peters, N. De Marchis, G.M. Thilemann, S. Avramiotis, N.S. Gensicke, H. Hert, L. Wagner, B. Schaub, F. Meya, L. Fladt, J. Dittrich, T. Fisch, U. Macha, K. Haupenthal, D. Gassmann, L. Wang, R. Stoll, S. Schwab, S. Volbers, B. Siedler, G. Kallmünzer, B. Cappellari, M. Bonetti, B. Bovi, P. Tomelleri, G. Micheletti, N. Zivelonghi, C. Emiliani, A. Parry-Jones, A. Patterson, C. Price, C. Elmarimi, A. Parry, A. Nallasivam, A. Nor, A.M. Esis, B. Bruce, D. Bhaskaran, B. Roffe, C. Cullen, C. Holmes, C. Cohen, D. Hargroves, D. Mangion, D. Chadha, D. Vahidassr, D. Manawadu, D. Giallombardo, E. Warburton, E. Flossman, E. Gunathilagan, G. Proschel, H. Emsley, H. Anwar, I. Burger, I. Okwera, J. Putterill, J. O’Connell, J. Bamford, J. Corrigan, J. Scott, J. Birns, J. Kee, K. Saastamoinen, K. Pasco, K. Dani, K. Sekaran, L. Choy, L. Iveson, L. Mamun, M. Sajid, M. Cooper, M. Burn, M. Smith, M. Power, M. Davis, M. Smyth, N. Veltkamp, R. Sharma, P. Guyler, P. O’Mahony, P. Wilkinson, P. Datta, P. Aghoram, P. Marsh, R. Luder, R. Meenakishundaram, S. Subramonian, S. Leach, S. Ispoglou, S. Andole, S. England, T. Manoj, A. Harrington, F. Rehman, H. Sword, J. Staals, J. Mahawish, K. Harkness, K. Shaw, L. McCormich, M. Sprigg, N. Mansoor, S. Krishnamurthy, V. Giustozzi, M. Acciarresi, M. Agnelli, G. Becattini, C. Alberti, A. D’Amore, C. Cimini, L.A. Bandini, F. Tsivgoulis, G. Liantinioti, C. Chondrogianni, M. Yaghi, S. Furie, K.L. Tadi, P. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Vannucchi, V. Masotti, L. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Mumoli, N. Galati, F. Sacco, S. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Colombo, G. Silvestrelli, G. Ciccone, A. Lanari, A. Scoditti, U. Denti, L. Mancuso, M. Maccarrone, M. Ulivi, L. Orlandi, G. Giannini, N. Tassinari, T. De Lodovici, M.L. Rueckert, C. Baldi, A. Toni, D. Letteri, F. Pieroni, A. Giuntini, M. Lotti, E.M. Flomin, Y. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Pallesen, L.-P. Barlinn, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Todo, K. Kimura, K. Shibazaki, K. Yagita, Y. Furui, E. Itabashi, R. Terasaki, T. Shiokawa, Y. Hirano, T. Suzuki, R. Kamiyama, K. Nakagawara, J. Takizawa, S. Homma, K. Okuda, S. Okada, Y. Maeda, K. Kameda, T. Kario, K. Nagakane, Y. Hasegawa, Y. Akiyama, H. Shibuya, S. Mochizuki, H. Ito, Y. Nakashima, T. Matsuoka, H. Takamatsu, K. Nishiyama, K. Tanaka, K. Endo, K. Miyagi, T. Osaki, M. Kobayashi, J. Okata, T. Tanaka, E. Sakamoto, Y. Tokunaga, K. Takizawa, H. Takasugi, J. Matsubara, S. Higashida, K. Matsuki, T. Kinoshita, N. Shiozawa, M. Ide, T. Yoshimoto, T. Ando, D. Fujita, K. Kumamoto, M. Kamimura, T. Kikuno, M. Mizoguchi, T. Sato, T. NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF Verona Registry Collaborators
Abstract: Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (
Published: 2022

15. Improving thrombolysis for acute ischemic stroke in Lombardia stroke centers

Author: Cavallini, A., Tartara, E., Marcheselli, S., Agostoni, E., Quaglini, S., and Micieli, G.
Published: 2013
Full Text: View/download PDF

16. Risk Factors for Intracerebral Hemorrhage in Patients with Atrial Fibrillation on Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention

Author: Paciaroni, M. Agnelli, G. Giustozzi, M. Caso, V. Toso, E. Angelini, F. Canavero, I. Micieli, G. Antonenko, K. Rocco, A. Diomedi, M. Katsanos, A.H. Shoamanesh, A. Giannopoulos, S. Ageno, W. Pegoraro, S. Putaala, J. Strbian, D. Sallinen, H. Mac Grory, B.C. Furie, K.L. Stretz, C. Reznik, M.E. Alberti, A. Venti, M. Mosconi, M.G. Vedovati, M.C. Franco, L. Zepponi, G. Romoli, M. Zini, A. Brancaleoni, L. Riva, L. Silvestrelli, G. Ciccone, A. Zedde, M.L. Giorli, E. Kosmidou, M. Ntais, E. Palaiodimou, L. Halvatsiotis, P. Tassinari, T. Saia, V. Ornello, R. Sacco, S. Bandini, F. Mancuso, M. Orlandi, G. Ferrari, E. Pezzini, A. Poli, L. Cappellari, M. Forlivesi, S. Rigatelli, A. Yaghi, S. Scher, E. Frontera, J.A. Masotti, L. Grifoni, E. Caliandro, P. Zauli, A. Reale, G. Marcheselli, S. Gasparro, A. Terruso, V. Arnao, V. Aridon, P. Abdul-Rahim, A.H. Dawson, J. Saggese, C.E. Palmerini, F. Doronin, B. Volodina, V. Toni, D. Risitano, A. Schirinzi, E. Del Sette, M. Lochner, P. Monaco, S. Mannino, M. Tassi, R. Guideri, F. Acampa, M. Martini, G. Lotti, E.M. Padroni, M. Pantoni, L. Rosa, S. Bertora, P. Ntaios, G. Sagris, D. Baldi, A. D'Amore, C. Mumoli, N. Porta, C. Denti, L. Chiti, A. Corea, F. Acciarresi, M. Flomin, Y. Popovic, N. Tsivgoulis, G.
Subjects: cardiovascular diseases
Abstract: Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA2DS2-VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA2DS2-VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA2DS2-VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468-0.525) and 0.530 (95% CI, 0.500-0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA2DS2-VASc scores. © 2021 Lippincott Williams and Wilkins. All rights reserved.
Published: 2021

17. Clinical Features of Patients with Cervical Artery Dissection and Fibromuscular Dysplasia

Author: Bonacina, S., Grassi, M., Zedde, M., Zini, A., Bersano, A., Gandolfo, Cinzia, Silvestrelli, G., Baracchini, C., Cerrato, P., Lodigiani, C., Marcheselli, S., Paciaroni, M., Rasura, M., Cappellari, M., Del Sette, M., Cavallini, A., Morotti, A., Micieli, G., Lotti, E. M., Delodovici, M. L., Gentile, Marino, Magoni, M., Azzini, C., Calloni, M. V., Giorli, E., Braga, M., La Spina, P., Melis, F., Tassi, R., Terruso, V., Calabro, R. S., Piras, V., Giossi, A., Locatelli, Martina, Mazzoleni, Valeria, Pezzini, D., Sanguigni, S., Zanferrari, C., Mannino, Maria, Colombo, Ilaria, Dallocchio, C., Nencini, P., Bignamini, V., Adami, A., Magni, Eugenio, Bella, R., Padovani, A., Pezzini, A., Gandolfo C., Gentile M., Locatelli M., Mazzoleni V., Mannino M., Colombo I., Magni E. (ORCID:0000-0002-2235-2280), Bonacina, S., Grassi, M., Zedde, M., Zini, A., Bersano, A., Gandolfo, Cinzia, Silvestrelli, G., Baracchini, C., Cerrato, P., Lodigiani, C., Marcheselli, S., Paciaroni, M., Rasura, M., Cappellari, M., Del Sette, M., Cavallini, A., Morotti, A., Micieli, G., Lotti, E. M., Delodovici, M. L., Gentile, Marino, Magoni, M., Azzini, C., Calloni, M. V., Giorli, E., Braga, M., La Spina, P., Melis, F., Tassi, R., Terruso, V., Calabro, R. S., Piras, V., Giossi, A., Locatelli, Martina, Mazzoleni, Valeria, Pezzini, D., Sanguigni, S., Zanferrari, C., Mannino, Maria, Colombo, Ilaria, Dallocchio, C., Nencini, P., Bignamini, V., Adami, A., Magni, Eugenio, Bella, R., Padovani, A., Pezzini, A., Gandolfo C., Gentile M., Locatelli M., Mazzoleni V., Mannino M., Colombo I., and Magni E. (ORCID:0000-0002-2235-2280)
Abstract: Background and Purpose: Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated. Methods: In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD-). Results: A total of 1283 sCeAD patients (mean age, 47.8±11.4 years; women, 545 [42.5%]) qualified for the analysis, of whom 103 (8.0%) were diagnosed with cFMD+. In multivariable analysis, history of migraine (odds ratio, 1.78 [95% CI, 1.13-2.79]), the presence of intracranial aneurysms (odds ratio, 8.71 [95% CI, 4.06-18.68]), and the occurrence of minor traumas before the event (odds ratio, 0.48 [95% CI, 0.26-0.89]) were associated with cFMD. After a median follow-up of 34.0 months (25th to 75th percentile, 60.0), 39 (3.3%) patients had recurrent sCeAD events. cFMD+ and history of migraine predicted independently the risk of recurrent sCeAD (hazard ratio, 3.40 [95% CI, 1.58-7.31] and 2.07 [95% CI, 1.06-4.03], respectively) in multivariable Cox proportional hazards analysis. Conclusions: Risk factor profile of sCeAD patients with cFMD differs from that of patients without cFMD. cFMD and migraine are independent predictors of midterm risk of sCeAD recurrence.
Published: 2021

18. Safety of Anticoagulation in Patients Treated with Urgent Reperfusion for Ischemic Stroke Related to Atrial Fibrillation

Author: Giustozzi, M. Acciarresi, M. Agnelli, G. Caso, V. Bandini, F. Tsivgoulis, G. Yaghi, S. Furie, K.L. Tadi, P. Becattini, C. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. D'Amore, C. Giulia Mosconi, M. Anna Cimini, L. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Liantinioti, C. Theodorou, A. Halvatsiotis, P. Mumoli, N. Galati, F. Sacco, S. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Silvestrelli, G. Ciccone, A. Lanari, A. Scoditti, U. Denti, L. Mancuso, M. Ferrari, E. Ulivi, L. Orlandi, G. Giannini, N. Tassinari, T. Luisa De Lodovici, M. Rueckert, C. Baldi, A. Toni, D. Letteri, F. Giuntini, M. Maria Lotti, E. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Maimone Baronello, M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Barlinn, J. Deleu, D. Gourbali, V. Paciaroni, M. Masotti, L.
Abstract: Background and Purpose: The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention. Methods: We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either Vitamin K antagonists or nonVitamin K oral anticoagulants. Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features. Results: A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]). Conclusions: Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant. © 2020 The Authors.
Published: 2020

19. Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes

Author: Paciaroni, M. Agnelli, G. Giustozzi, M. Tsivgoulis, G. Yaghi, S. Grory, B.M. Furie, K.L. Tadi, P. Zedde, M. Abdul-Rahim, A.H. Dawson, J. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. D’Amore, C. Mosconi, M.G. Bogini, V. Cappellari, M. Rigatelli, A. Bonetti, B. Putaala, J. Tomppo, L. Tatlisumak, T. Bandini, F. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Masotti, L. Grifoni, E. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Liantinioti, C. Palaiodimou, L. Mumoli, N. Porta, C. Galati, F. Sacco, S. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Silvestrelli, G. Ciccone, A. Scoditti, U. Denti, L. Mancuso, M. Caselli, M.C. Maccarrone, M. Ulivi, L. Orlandi, G. Giannini, N. Tassinari, T. Lodovici, M.L.D. Rueckert, C. Baldi, A. Toni, D. Gentile, L. Letteri, F. Giuntini, M. Lotti, E.M. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Mannino, M. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Sette, M.D. Schirinzi, E. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Eskandari, A. Vanacker, P. Barlinn, K. Barlinn, J. Deleu, D. Gourbali, V. Caso, V.
Abstract: Introduction: The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing. Materials and Methods: Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke. Results: A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39–2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16–1.80). Discussion: our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events. Conclusions: Patients with PS or AS and AF appear to have similar risks of ischaemic or haemorrhagic events at 90 days with no difference concerning the timing of initiation of OAT. © European Stroke Organisation 2020.
Published: 2020

20. Endovascular Thrombectomy for Acute Ischemic Stroke beyond 6 Hours from Onset: A Real-World Experience

Author: Casetta, I., Fainardi, E., Saia, V., Pracucci, G., Padroni, M., Renieri, L., Nencini, P., Inzitari, D., Morosetti, D., Sallustio, F., Vallone, S., Bigliardi, G., Zini, A., Longo, M., Francalanza, I., Bracco, S., Vallone, I. M., Tassi, R., Bergui, M., Naldi, A., Saletti, A., De Vito, A., Gasparotti, R., Magoni, M., Castellan, L., Serrati, C., Menozzi, R., Scoditti, U., Causin, F., Pieroni, A., Puglielli, E., Casalena, A., Sanna, A., Ruggiero, M., Cordici, F., Di Maggio, L., Duc, E., Cosottini, M., Giannini, N., Sanfilippo, G., Zappoli, F., Toni, D., Cavasin, N., Critelli, A., Ciceri, E., Plebani, M., Cappellari, M., Chiumarulo, L., Petruzzellis, M., Terrana, A., Cariddi, L. P., Burdi, N., Tinelli, A., Auteri, W., Silvagni, U., Biraschi, F., Nicolini, E., Padolecchia, R., Tassinari, T., Filauri, P., Sacco, S., Pavia, M., Invernizzi, P., Nuzzi, N. P., Marcheselli, S., Amista, P., Russo, M., Gallesio, I., Craparo, G., Mannino, M., and Mangiafico, S.
Subjects: Male, medicine.medical_specialty, Middle Cerebral Artery, Time Factors, cerebral blood volume, collateral circulation, groin, intracranial hemorrhage, middle cerebral artery, thrombectomy, Ischemia, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, 030212 general & internal medicine, Acute ischemic stroke, Stroke, Aged, Advanced and Specialized Nursing, medicine.diagnostic_test, Groin, business.industry, Endovascular Procedures, Ambientale, Middle Aged, medicine.disease, Collateral circulation, Intracranial Hemorrhages/*surgery Ischemia/surgery Male Middle Aged Middle Cerebral Artery/physiopathology/surgery Stroke/*surgery Thrombectomy/methods Time Factors cerebral blood volume collateral circulation, Cerebral Angiography, medicine.anatomical_structure, Middle cerebral artery, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Thrombectomy, Cerebral angiography
Abstract: Background and Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. Results: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). Conclusions: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
Published: 2020

21. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Author: Morandi, A, Zambon, A, Di Santo SG, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Marengoni, A, Bellelli, G, Rispoli, V, Malara, A, Spadea, F, Di Cello, S, Ceravolo, F, Fabiano, F, Chiaradia, G, Amedeo, G, Peluso, L, Taristano, A, Settembrini, V, Capomolla, D, Citrino, A, Scriva, A, Bruno, I, Secchi, R, De Martino, E, Muccinelli, R, Lupi, G, Paonessa, P, Fabbri, A, Passuti, Mt, Castellari, S, Po, A, Gaggioli, G, Varesi, M, Moneti, P, Capurso, S, Latini, V, Ghidotti, S, Riccardelli, F, Macchi, M, Rigo, R, Pascale, C, Bosio, A, Cerrato, F, Bardelli, B, Boffelli, S, Cassinadri, A, Franzoni, S, Spazzini, E, Andretto, D, Tonini, G, Andreani, L, Coralli, M, Balotta, A, Cancelliere, R, Ballardini, G, Simoncelli, M, Mancini, A, Strazzacapa, M, Cavallino, P, Fabio, S, De Filippi, F, Giudice, C, Floris, P, D’Elia, K, Dentizzi, C, Azzini, M, Cazzadori, M, Mastroeni, V, Bertassello, P, Santana, H, Benati, C, Nesta, E, Tobaldini, C, Antonioli, A, Guerini, F, Tambare, E, Mombelloni, P, Fontanini, F, Lassa, G, Pizzorni, C, Oliverio, M, Del Grosso LL, Giavedoni, C, Bidoli, G, Mazzei, B, Corsonello, A, Fusco, S, Vena, S, De Vuono, T, Maiuri, G, Fimognari, Fl, Arone, A, Sgrò, G, Nicolazzo, R, Castegnaro, E, De Rosa, S, Bazzano Sechi, R, Benvenuti, E, Del Lungo, I, Giardini, S, Giulietti, C, Di Bari, M, Barghini, E, Paoli, M, Fiordelli, I, Barucci, R, Sgrilli, F, Bertoletti, E, D'Amico, F, Caronzolo, F, Grippa, A, Lombardo, G, Pipicella, T, Satta, A, Corica, F, Prestipino, Gv, Larosa, D, Cucinotta, D, Basile, G, March, A, Nitti, Mt, Felici, A, Pavan, S, Piazzani, F, Lunelli, A, Dimori, S, Margotta, A, Soglia, T, Postacchini, D, Brunelli, R, Santini, S, Francavilla, M, Macchiati, I, Sorvillo, F, Giuli, C, Mecocci, P, Longo, A, Conestabile della Staffa, M, Perticone, F, Addesi, D, Cella Rosa, P, Bencardino, G, Falbo, T, Grillo, N, Marco, F, Mirella, F, Fantò, F, Isaia, G, Pezzilli, S, Bergamo, D, Furno, E, Rrodhe, S, Lucarini, S, Dijk, B, Dall'Acqua, F, Cappelletto, F, Calvani, D, Becheri, D, Mottino, G, Mitidieri, C, Vito, A, Bartalucci, F, Magherini, L, Malin, N, Boni, F, Gambardella, L, Valente, C, Bracali, I, Foschini, A, Porrino, P, Ceci, G, Bottignole, G, Tibaldi, M, Coppo, E, Ettore, E, Camellini, C, Servello, A, Grassi, A, Rozzini, R, Tironi, S, Grassi, Mg, Troisi, E, Caltagirone, C, Franchini, F, Ratto, F, Pavani, B, Toniolo, S, Gabutto, A, Quazzo, L, Rosatello, A, Suraci, D, Tagliabue, B, Perrone, C, Ferrara, L, Castagna, A, Tremolada, Ml, Castoldi, G, Barbero, S, Oltramonti, D, Piano, S, Serviddio, G, Lo Buglio, A, Gurrera, T, Merlo, V, Rovai, C, Cotroneo, Am, Carlucci, R, Abbaldo, A, Monzani, F, Qasem, Aa, Bini, G, Tafuto, S, Galli, G, Bruni, Ac, Mancuso, G, Calipari, D, De Luca GM, Bernardini, B, Corsini, C, Ciccarelli, M, Dal Farra, S, Cagnin, A, Fragiacomo, F, Pompanin, S, Amodio, P, Cagnin, M, Zurlo, A, Guerra, G, Pala, M, Menozzi, L, Delli Gatti, C, Magon, S, Manfredini, R, De Giorgi, A, Fabbian, F, Tiseo, R, Misurati, E, Boari, B, Molino, C, Gallerani, M, Di Francesco, V, Faccioli, S, Pellizzari, L, Fontana, G, Barbagallo, G, Limone, G, Lunardelli, Ml, Martini, E, Ferrari, E, Macchiarulo, M, Corneli, M, Bacci, M, Battaglia, G, Anastasio, L, Lo Storto MS, Seresin, C, Simonato, M, Loreggian, M, Cestonaro, F, Durando, M, Latella, R, Mazzoleni, M, Russo, G, Ponte, M, Valchera, A, Salustri, G, Petritola, D, Costa, A, Sinforiani, E, Cotta, Mr, Pizio, Rn, Cester, A, Formilan, M, Bonometto, P, Carbone, P, Cazzaniga, I, Appollonio, I, Cereda, D, Stabile, A, Xhani, R, Acampora, R, Tremolizzo, L, Pieruzzi, F, Ciaccio, A, Pontecorvi, V, Butti, C, Mokini, Z, Vitale, G, Amigoni, M, Sparacino, M, Bottacchi, E, Bucciantini, E, Di Giovanni, M, Franchi, F, Lucchetti, L, Mariani, C, Grande, G, Rapazzini, P, Mauri, M, Romanelli, G, Nicosia, F, Margola, A, Bonardelli, A, Latronico, N, Porcella, L, Portolani, N, Concoreggi, C, Grassini, C, Salvi, A, Banchetti, L, Spagnoli, F, Apuzzo, R, Fontanella, M, Ceraso, A, Castelli, F, Fugazza, L, Guerrini, C, De Paduanis, G, Iallonardo, L, Palumbo, P, Zuliani, G, Ortolani, B, Capatti, E, Soavi, C, Bianchi, L, Francesconi, D, Miselli, A, Brombo, G, Romagnoli, T, Pazzaglini, C, Dall’Agata, M, Suardi, T, Zaccarini, C, Riva, M, Mirra, G, Muti, E, Bottura, R, Gianpaolo, M, Secreto, P, Bisio, E, Cecchettani, M, Naldi, T, Pallavicino, A, Pugliese, M, Iozzo, Rc, Grassi, G, Bombelli, M, Dell’Oro, R, Quarti Trevano, F, Giussani, Cg, Paternò, G, Contro, E, Mannironi, A, Giorli, E, Oberti, S, Fierro, B, Piccoli, T, Giacalone, F, Mandas, A, Serchisu, L, Costaggiu, D, Pinna, E, Orrù, F, Mannai, M, Cordioli, Z, Pelizzari, L, Turcato, E, Arduini, P, Cacace, C, Rimondi, B, Chiloiro, R, Cimino, R, Ruberto, C, Ruotolo, G, Gareri, P, Greco, L, Dal Santo, P, Andriolli, A, Burattin, G, Rossi, L, Cervati, G, Andreolli, A, Catalano, G, Tezza, F, Pizzardini, M, Laura, S, Crippa, P, Aloisio, P, Di Monda, T, Malighetti, A, Galbassini, G, Ivaldi, C, Russo, Am, Bennati, E, Pino, E, Zavarise, G, Pesci, 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A., Morandi A., Zambon A., Di Santo S.G., Mazzone A., Cherubini A., Mossello E., Bo M., Marengoni A., Piccoli T., Bellelli G., Rispoli V., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Chiaradia G., Gabriele A., Lenino P., Andrea T., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Passuti M.T., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Rigo R., Claudio P., Angelo B., Flavio C., Benedetta B., Boffelli S., Cassinadri A., Franzoni S., Spazzini E., Andretto D., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Ballardini G., Simoncelli M., Mancini A., Strazzacapa M., Fabio S., De Filippi F., Giudice C., Dentizzi C., Azzini M., Cazzadori M., Mastroeni V., Bertassello P., Claudia Benati H.S., Nesta E., Tobaldini C., Guerini F., Elena T., Mombelloni P., Fontanini F., Gabriella L., Pizzorni C., Oliverio M., Del Grosso L.L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Luca F.F., Andrea A., Giovanni S., Rossella N., Castegnaro E., De Rosa S., Sechi R.B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., Mauro D.B., Eleonora B., Martina P., Irene F., Riccardo B., Federica S., Ilaria D.L., Bertoletti E., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Antonino S., Francesco C., Valeria P.G., Daniela L., Domenico C., Giorgio B., March A., Nitti M.T., Felici A., Pavan S., Piazzani F., Lunelli A., Dimori S., Margotta A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Mecocci P., Longo A., Perticone F., Addesi D., Rosa P.C., Bencardino G., Falbo T., Grillo N., Marco F., Mirella F., Fanto F., Isaia G., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dijk B., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Giuseppe M., Costanza M., Vito A., Francesca B., Magherini L., Novella M., Franca B., Lucia Gambardella P.M., Valente C., Ilaria B., Alice F., Porrino P., Ceci G., Giuliana B., Michela T., Eleonora C., Ettore E., Camellini C., Servello A., Grassi A., Rozzini R., Tironi S., Grassi M.G., Troisi E., Carlo C., Simona Gabriella D.S., Flaminia F., Federica R., Beatrice P., Sofia T., Gabutto A., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M.L., Giuseppe C., Stefano B., Davide O., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Cotroneo A.M., Carlucci R., Abbaldo A., Monzani F., Qasem A.A., Bini G., Tafuto S., Galli G., Bruni A.C., Mancuso G., Calipari D., Giuseppe Massimiliano D.L., Bernardini B., Corsini C., Michele C., Sara D.F., Cagnin A., Fragiacomo F., Pompanin S., Piero A., Marco C., Zurlo A., Guerra G., Pala M., Menozzi L., Gatti C.D., Magon S., Roberto M., Alfredo D.G., Fabio F., Ruana T., Elisa M., Christian M., Marco P., Massimo G., Di Francesco V., Faccioli S., Pellizzari L., Giorgia F., Barbagallo G., Lunardelli M.L., Martini E., Ferrari E., Macchiarulo M., Corneli M., Bacci M., Battaglia G., Anastasio L., Lo Storto M.S., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Latella R., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Petritola D., Costa A., Sinforiani E., Cotta M.R., Pizio R.N., Cester A., Formilan M., Pietro B., Carbone P., Cazzaniga I., Appollonio I., Cereda D., Stabile A., Xhani R., Acampora R., Tremolizzo L., Federico P., Antonio C., Valerio P., Cesare B., Zhirajr M., Giovanni V., Maria A., Mariaelena S., Bottacchi E., Bucciantini E., Di Giovanni M., Franchi F., Lucchetti L., Mariani C., Grande G., Rapazzini P., Marco M., Romanelli G., Franco N., Alessio M., Nicola L., Laura P., Nazario P., Chiara G., Soccorso P., Andrea S., Luca B., Francesca S., Roberto A., Anna C., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Zuliani G., Ortolani B., Capatti E., Soavi C., Bianchi L., Francesconi D., Miselli A., Gloria B., Tommaso R., Chiara P., Agata M.M., Marco D.A., Luca M., Gianluca G., Suardi T., Zaccarini C., Manuela R., Mirra G., Muti E., Bottura R., Gianpaolo M., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R.C., Grassi G., Michele B., Raffaella D.O., Fosca Q.T., Giorgio G.C., Giovanni P., Ernesto C., Mannironi A., Giorli E., Oberti S., Fierro B., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Santo P.D., Andriolli A., Burattin G., Rossi L., Andreolli Antonino C.G., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Salutis D., Ivaldi C., Russo A.M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M.R., Martellini E., Enrico M., Monica T., Antonella G., Giovanna L., Migliorini M., Caramelli F., Battiston B., Berardino M., Cavallo S., Alessandro M., Anna S., Lombardi B., D'Ippolito P., Furini A., Villani D., Clara R., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Rosa C.A., Loredana B., Imoscopi A., Tibaldi V., Bottignole G G., Calvi E., Clementi C., Zanocchi M., Agosta L., Nortarelli A., Provenzano G., Mari D., Romano F.Y., Rosini F., Mansi M., Rossi S., Geriatria A.R., Inzaghi L., Bonini G., Rossi P., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Alessandra P., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Giulia C., Lorenzo M., Odetti P., Monacelli F., Prefumo M., Fiammetta M., Canepa M., Minaglia C., Paolisso G., Rizzo M.R., Prestano R., Dalise A.M., Barra D., Bosco L.D., Asprinio V., Dallape L., Perina E., Incalzi R.A., Bartoli I.R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P.L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M.C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A.M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A.C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P.M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P.F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Barbujani M., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D.M., Casella M., Prampolini R., Scevola M., Vitale E., Roberto B., Carlo F., Sergio F., Alberto S., Daniela Z., Giulia B., Serena G., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Fabbo A., Palmieri M., Zoli M., Forti P., Pirazzoli L., Fabbri E., Terenzi L., Bergolari F., Wenter C., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Antonino L., Basile G., Grazia A.M., Parise P., Boccali A., Amici S., Gambacorta M., Lasagni A., Lovati R., Giovinazzo F., Kimak E., Zappa P., Medici F., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Padovani A., Rozzini L., Ceraso A., Salvatore C., Cottino M., Vitali S., Marelli E., Tripi G., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Avanzi S., Serena S., Claudia C., Marilena V., Alberto L., Diego G., Alessandro G., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Mussi C., Neviani F., Roberto C., Valentina G., Linda M., Francesca V., Tarozzi A., Balestri F., Mannarino G., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Annoni G., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Mazzola P., Perego S., Persico I., Olivieri G., Bonfanti A., Hajnalka S., Galeazzi M., Massariello F., Anzuini A., Caffarra P., Barocco F., Spallazzi M., Paolo C.G., Simonetta M., Chioatto P., Bortolamei S., Soattin L., Ruotolo G., Beneamino B., Giuseppe B., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Fabbro A.D., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Boschi F., Biondi M., Fiumi N., Erika T., Locatelli S.M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A.C., Bonino P., Caput M., Antonietti M.P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Marchionni N., Sabatini T., Mussio E., Magni E., Bianchetti A., Crucitti A., Titoldini G., Cossu B., Fascendini S., Licini C., Tomasoni A., Calderazzo M., Daniela T., Valentina L., Melotti R.M., Lilli A., Buda S., Adversi M., Noro G., Turco R., Ubezio M.C., Mantovani A.R., Viola M.C., Serrati C., Pretta S., Infante M., Gentile S., D'Ambrosio V., Mazzanti P., Brambilla C., Sportelli S., Platto C., Faraci B., Quattrocchi D., Pernigotti L.M., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Biagini C.A., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Filomena B., Bonanni L., Gabriella C., Comi G., Magnani G., Santangelo R., Mazzeo S., Francesca C., Giordano C., Roberto S.A., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Piccininni M., Tassinari T., Brogi D., Sugo A., Alessandra F., Sonia M., Valerio V., Andrea U.C., Enrico C., Vera R.F., Assunta S., Gianmaria Z., Mauro P., Barone A., Razzano M., Giuseppe I., Angela B., Francesco S., Valeria D.A., Federico G., Lucia P., Antonella V., Elisabetta D.C., Cristina R., Nadia C., Maria S., Luciano A., Chiara C., Bini P., Pignata M., Enrico B., Maria V., Giovanni C., Giorgio C., Piera R., Alberto Z., Ceccon A., Magrin L., Marin S., Barbara S., Matteo M., Caterina P.M., Carla R., Federica G., Clara T., Melania C., Giampaolo B., Stefano G., Valeria G., Lucia M., Giovambattista D., Ester L., Cecilia C.A., Maurizio T., Nadia B., Grillo A., Arenare F., Tonino M., David K., Giorgio V.P., Ubaldo B., Vincenzo S., Stefano M., Marino F., Busonera Flavio M.T., Paolo A., Monica M., Francesco B., Roberto F., Paolo B., DuranteMangoni E., Testoni M., Fabio D.S., Loredana S., Valeria S., Fabiano M., Annabella D.G., Salvatore D.C., Greco A., Grazia D.O., Daniele S., Gianluca R., Renzo G., Sergio M., Morena B., Vitali M., Marina P., Paolo D.C., Cristina S., Orlandini F., La Regina M., Desiree A., Mario B., Paola P., Padulo F., Cristina M., Dario R., Giancarla M., Guido R., Elena M., Marileda N., Igor B., Nicole B., Elena R., Paolillo C., Riccardi A., Claudia B., Barbara R., Silvia V., Oliver B., Mauro C., Eleonora M., Giuseppe P., Rosaria T., Maria C., Davide D.A., Stefania C., Massimo P., Luca S., Martina D.F., Paola V., Lia S., Sandro C., Valentina D.S., Erminia B., Paola C., Romina R., Minisola S., Luciano C., Pasquale A., Ilaria L., Guglielmo S., Marco E., Sara R., Paola A., Claudio A., Francesco R., Alessandro C., Simona M., Lara F., Paola R., Simonetta C., Antonella C., Generoso U., Fernando G., Giuliano C., Emanuela S., Mariolina S., Alessandro D., Giulia L., Famularo S., Sandini M., Pinotti E., Gianotti L., Antonella B., Giulia P., Sante G., Rossi A., Rubele S., Sant S., Marco V., Danila C., Fabio R., Bandirali M.P., Nicoletta C., Laura B., Paolo T., Luciano T., Leonello A., Margherita S., Stefania D.N., Pierluigi D.S., Laura R., Fabiana T., Giovanna C., Antonino A., Felice C., Danilo F., Giovanna D.B., Francesco L., Salini S., Angela B.M., Giorgetta C., Giovanni G., Gerardo B., Silvio R., Letizia S., Davide B., Rosaria R.M., Maria D.A., Raffaele P., Palmieri V.O., Palasciano G., Belfiore A., Portincasa P., Carlo S., Alessia D., Valiani V., Carolina B., Tiziana C., Paola T., Ugo P., Giacomo P., Castellano M., Anna G., Elisa C., Federica C., Antonietta C.M., Luigi M., Fabio L., Salvatore B., Gelosa G., Viviana A.T., Piras V., Andrea C., Alessandra B., Coen D., Magliola R., Milanesio D., Muzzulini C.L., Paolo F., Marinella T., Sofia C.M., Marta B., Siano P., Capo G., Napoletano R., Cecilia P., Mancini C., Del Buono C., De Bartolomeo G., Addolorata M., Carmen C., Giovanni V.A., Moschettini G., Franco M., Daniela R., D'Amico G., Mirella P., Endrizzi C., Trotta L., Ciarambino T., Orazio Z., Emanuela T., Marta S., Thomas F., Giacomo T., Ignazio D.F., Andrea B., Giuseppe O., Emanuela F., Serena A., Elena D.I., Serena B., Erika N., Roberto S., Elena S., Manuela P., Francesca A., Angelo T., Morandi, A, Zambon, A, Di Santo, S, Mazzone, A, Cherubini, A, 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C, Cucinotta, D, Antonino, L, Basile, G, Grazia, A, Parise, P, Boccali, A, Amici, S, Gambacorta, M, Lasagni, A, Lovati, R, Giovinazzo, F, Kimak, E, Zappa, P, Medici, F, Lo Castro, M, Mauro, F, De Luca, A, Sancesario, G, Martorana, A, Scaricamazza, B, Toniolo, S, Di Lorenzo, F, Liguori, C, Lasco, A, Vita, N, Giomi, M, Forte, F, Padovani, A, Rozzini, L, Ceraso, A, Salvatore, C, Cottino, M, Vitali, S, Marelli, E, Tripi, G, Miceli, S, Urso, G, Grioni, G, Vezzadini, G, Misaggi, G, Forlani, C, Avanzi, S, Serena, S, Claudia, C, Marilena, V, Alberto, L, Diego, G, Alessandro, G, Iemolo, F, Sanzaro, E, D'Asta, G, Proietto, M, Carnemolla, A, Razza, G, Spadaro, D, Bertolotti, M, Mussi, C, Neviani, F, Roberto, C, Valentina, G, Linda, M, Francesca, V, Tarozzi, A, Balestri, F, Mannarino, G, Bigolari, M, Natale, A, Grassi, S, Bottaro, C, Stefanelli, S, Bovone, U, Tortorolo, U, Quadri, R, Leone, G, Ponzetto, M, Frasson, P, Annoni, G, Confalonieri, R, Corsi, M, Moretti, D, Teruzzi, F, Umidi, S, Mazzola, P, Perego, S, Persico, I, Olivieri, G, Bonfanti, A, Hajnalka, S, Galeazzi, M, Massariello, F, Anzuini, A, Caffarra, P, Barocco, F, Spallazzi, M, Paolo, C, Simonetta, M, Chioatto, P, Bortolamei, S, Soattin, L, Ruotolo, G, Beneamino, B, Giuseppe, B, Bertazzoli, M, Rota, E, Adobati, A, Scarpa, A, Granziera, S, Zuccher, P, Fabbro, A, Zara, D, Lo Nigro, A, Franchetti, L, Toniolo, M, Marcuzzo, C, Rollone, M, Guerriero, F, Sgarlata, C, Masse, A, Zatti, G, Piatti, M, Graci, J, Benati, G, Boschi, F, Biondi, M, Fiumi, N, Erika, T, Locatelli, S, Mauri, S, Beretta, M, Margheritis, L, Desideri, G, Liberatore, E, Carucci, A, Bonino, P, Caput, M, Antonietti, M, Polistena, G, De la Pierre, F, Mari, M, Massignani, P, Tombesi, F, Selvaggio, F, Verbo, B, Bodoni, P, Marchionni, N, Sabatini, T, Mussio, E, Magni, E, Bianchetti, A, Crucitti, A, Titoldini, G, Cossu, B, Fascendini, S, Licini, C, Tomasoni, A, Calderazzo, M, Daniela, T, Valentina, L, Melotti, R, Lilli, A, Buda, S, Adversi, M, Noro, G, Turco, R, Ubezio, M, Mantovani, A, Viola, M, Serrati, C, Pretta, S, Infante, M, Gentile, S, D'Ambrosio, V, Mazzanti, P, Brambilla, C, Sportelli, S, Platto, C, Faraci, B, Quattrocchi, D, Pernigotti, L, Pisu, C, Sicuro, F, Zagnoni, P, Ghiglia, S, Mosca, M, Corazzin, I, Deola, M, Biagini, C, Bencini, F, Cantini, C, Tonon, E, Pierinelli, S, Onofrj, M, Thomas, A, Filomena, B, Bonanni, L, Gabriella, C, Comi, G, Magnani, G, Santangelo, R, Mazzeo, S, Francesca, C, Giordano, C, Roberto, S, Barbieri, C, Giroldi, L, Bandini, F, Masina, M, Malservisi, S, Cicognani, A, Ricca, L, Piccininni, M, Tassinari, T, Brogi, D, Sugo, A, Alessandra, F, Sonia, M, Valerio, V, Andrea, U, Enrico, C, Vera, R, Assunta, S, Gianmaria, Z, Mauro, P, Barone, A, Razzano, M, Giuseppe, I, Angela, B, Francesco, S, Valeria, D, Federico, G, Lucia, P, Antonella, V, Elisabetta, D, Cristina, R, Nadia, C, Maria, S, Luciano, A, Chiara, C, Bini, P, Pignata, M, Enrico, B, Maria, V, Giovanni, C, Giorgio, C, Piera, R, Alberto, Z, Ceccon, A, Magrin, L, Marin, S, Barbara, S, Matteo, M, Caterina, P, Carla, R, Federica, G, Clara, T, Melania, C, Giampaolo, B, Stefano, G, Valeria, G, Lucia, M, Giovambattista, D, Ester, L, Cecilia, C, Maurizio, T, Nadia, B, Grillo, A, Arenare, F, Tonino, M, David, K, Giorgio, V, Ubaldo, B, Vincenzo, S, Stefano, M, Marino, F, Busonera Flavio, M, Paolo, A, Monica, M, Francesco, B, Roberto, F, Paolo, B, Durantemangoni, E, Testoni, M, Fabio, D, Loredana, S, Valeria, S, Fabiano, M, Annabella, D, Salvatore, D, Greco, A, Grazia, D, Daniele, S, Gianluca, R, Renzo, G, Sergio, M, Morena, B, Vitali, M, Marina, P, Paolo, D, Cristina, S, Orlandini, F, La Regina, M, Desiree, A, Mario, B, Paola, P, Padulo, F, Cristina, M, Dario, R, Giancarla, M, Guido, R, Elena, M, Marileda, N, Igor, B, Nicole, B, Elena, R, Paolillo, C, Riccardi, A, Claudia, B, Barbara, R, Silvia, V, Oliver, B, Mauro, C, Eleonora, M, Giuseppe, P, Rosaria, T, Maria, C, Davide, D, Stefania, C, Massimo, P, Luca, S, Martina, D, Paola, V, Lia, S, Sandro, C, Valentina, D, Erminia, B, Paola, C, Romina, R, Minisola, S, Luciano, C, Pasquale, A, Ilaria, L, Guglielmo, S, Marco, E, Sara, R, Paola, A, Claudio, A, Francesco, R, Alessandro, C, Simona, M, Lara, F, Paola, R, Simonetta, C, Antonella, C, Generoso, U, Fernando, G, Giuliano, C, Emanuela, S, Mariolina, S, Alessandro, D, Giulia, L, Famularo, S, Sandini, M, Pinotti, E, Gianotti, L, Antonella, B, Giulia, P, Sante, G, Rossi, A, Rubele, S, Sant, S, Marco, V, Danila, C, Fabio, R, Bandirali, M, Nicoletta, C, Laura, B, Paolo, T, Luciano, T, Leonello, A, Margherita, S, Pierluigi, D, Laura, R, Fabiana, T, Giovanna, C, Antonino, A, Felice, C, Danilo, F, Giovanna, D, Francesco, L, Salini, S, Giorgetta, C, Giovanni, G, Gerardo, B, Silvio, R, Letizia, S, Davide, B, Rosaria, R, Maria, D, Raffaele, P, Palmieri, V, Palasciano, G, Belfiore, A, Portincasa, P, Carlo, S, Alessia, D, Valiani, V, Carolina, B, Tiziana, C, Paola, T, Ugo, P, Giacomo, P, Castellano, M, Anna, G, Elisa, C, Federica, C, Antonietta, C, Luigi, M, Fabio, L, Salvatore, B, Gelosa, G, Viviana, A, Piras, V, Andrea, C, Alessandra, B, Coen, D, Magliola, R, Milanesio, D, Muzzulini, C, Paolo, F, Marinella, T, Sofia, C, Marta, B, Siano, P, Capo, G, Napoletano, R, Cecilia, P, Mancini, C, Del Buono, C, De Bartolomeo, G, Addolorata, M, Carmen, C, Moschettini, G, Franco, M, Daniela, R, D'Amico, G, Mirella, P, Endrizzi, C, Trotta, L, Ciarambino, T, Orazio, Z, Emanuela, T, Marta, S, Thomas, F, Giacomo, T, Ignazio, D, Andrea, B, Giuseppe, O, Emanuela, F, Serena, A, Elena, D, Serena, B, Erika, N, Elena, S, Manuela, P, Francesca, A, Angelo, T, Di Santo SG, Rizzo, Maria Rosaria, Paolisso, Giuseppe, and Italian Study Group on Delirium, (ISGoD).
Subjects: Rehabilitation hospital, medicine.medical_specialty, Urinary system, Socio-culturale, dementia, elderly, Motor subtypes of delirium, Aged, Cross-Sectional Studies, Humans, Inpatients, Italy, Delirium, Dementia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, mental disorders, medicine, Motor subtypes of delirium, dementia, elderly, dementia, elderly, Motor subtypes of delirium, 030212 general & internal medicine, LS4_4, Medical prescription, General Nursing, Psychomotor learning, business.industry, Health Policy, Medical record, Memantine, General Medicine, medicine.disease, Settore MED/26 - NEUROLOGIA, Geriatrics and Gerontology, medicine.symptom, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: Objectives Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian point-prevalence study. Setting and participants Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and implications In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.
Published: 2020

22. A possible case of unruptured middle cerebral artery aneurysm presenting as epileptic seizures

Author: Zambrelli, E., Cavallini, A., Tosi, P., Marcheselli, S., Giardini, G., Pichiecchio, A., and Micieli, G.
Published: 2003
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23. Thrombolysis and bridging therapy in patients with acute ischaemic stroke and Covid‐19

Author: Cappellari, M., primary, Zini, A., additional, Sangalli, D., additional, Cavallini, A., additional, Reggiani, M., additional, Sepe, F. N., additional, Rifino, N., additional, Giussani, G., additional, Guidetti, D., additional, Zedde, M., additional, Marcheselli, S., additional, Longoni, M., additional, Beretta, S., additional, Sidoti, V., additional, Papurello, D. M., additional, Giossi, A., additional, Nencini, P., additional, Plocco, M., additional, Balestrino, M., additional, Rota, E., additional, and Toni, D., additional
Published: 2020
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24. Computerised Guidelines Implementation: Obtaining Feedback for Revision of Guidelines, Clinical Data Model and Data Flow

Author: Panzarasa, S., primary, Quaglini, S., additional, Cavallini, A., additional, Marcheselli, S., additional, Stefanelli, M., additional, and Micieli, G., additional
Published: 2007
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25. Anticoagulation after Stroke in Patients with Atrial Fibrillation: To Bridge or Not with Low-Molecular-Weight Heparin?

Author: Altavilla, R. Caso, V. Bandini, F. Agnelli, G. Tsivgoulis, G. Yaghi, S. Furie, K.L. Tadi, P. Becattini, C. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. D'Amore, C. Giulia Mosconi, M. Anna Cimini, L. Fusaro, J. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Masotti, L. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Liantinioti, C. Chondrogianni, M. Mumoli, N. Consoli, D. Galati, F. Sacco, S. Carolei, A. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Silvestrelli, G. Ciccone, A. Lanari, A. Scoditti, U. Denti, L. Mancuso, M. MacCarrone, M. Ulivi, L. Orlandi, G. Giannini, N. Gialdini, G. Tassinari, T. De Lodovici, M.L. Bono, G. Rueckert, C. Baldi, A. D'Anna, S. Toni, D. Letteri, F. Giuntini, M. Lotti, E.M. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Pallesen, L.-P. Barlinn, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Paciaroni, M.
Abstract: Background and Purpose-Bridging therapy with low-molecular-weight heparin reportedly leads to a worse outcome for acute cardioembolic stroke patients because of a higher incidence of intracerebral bleeding. However, this practice is common in clinical settings. This observational study aimed to compare (1) the clinical profiles of patients receiving and not receiving bridging therapy, (2) overall group outcomes, and (3) outcomes according to the type of anticoagulant prescribed. Methods-We analyzed data of patients from the prospective RAF and RAF-NOACs studies. The primary outcome was defined as the composite of ischemic stroke, transient ischemic attack, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding observed at 90 days after the acute stroke. Results-Of 1810 patients who initiated oral anticoagulant therapy, 371 (20%) underwent bridging therapy with full-dose low-molecular-weight heparin. Older age and the presence of leukoaraiosis were inversely correlated with the use of bridging therapy. Forty-two bridged patients (11.3%) reached the combined outcome versus 72 (5.0%) of the nonbridged patients (P=0.0001). At multivariable analysis, bridging therapy was associated with the composite end point (odds ratio, 2.3; 95% CI, 1.4-3.7; P
Published: 2019

26. Early recurrence in paroxysmal versus sustained atrial fibrillation in patients with acute ischaemic stroke

Author: Paciaroni, M. Angelini, F. Agnelli, G. Tsivgoulis, G. Furie, K.L. Tadi, P. Becattini, C. Falocci, N. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. Altavilla, R. D’Amore, C. Mosconi, M.G. Cimini, L.A. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Bandini, F. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Masotti, L. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Karagkiozi, E. Athanasakis, G. Makaritsis, K. Vadikolias, K. Liantinioti, C. Chondrogianni, M. Mumoli, N. Consoli, D. Galati, F. Sacco, S. Carolei, A. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Silvestrelli, G. Ciccone, A. Scoditti, U. Denti, L. Mancuso, M. Maccarrone, M. Orlandi, G. Giannini, N. Gialdini, G. Tassinari, T. Lodovici, M.L.D. Bono, G. Rueckert, C. Baldi, A. Toni, D. Letteri, F. Giuntini, M. Lotti, E.M. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Sette, M.D. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel Pd-Mer, P. Vanacker, P. Barlinn, K. Pallesen, L.P. Kepplinger, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Yaghi, S. Caso, V.
Subjects: cardiovascular system, macromolecular substances, cardiovascular diseases
Abstract: Background: The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose: In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods: In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results: A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions: After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence. © European Stroke Organisation 2018.
Published: 2019

27. Causes and Risk Factors of Cerebral Ischemic Events in Patients with Atrial Fibrillation Treated with Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention: The RENo Study

Author: Paciaroni, M. Agnelli, G. Caso, V. Silvestrelli, G. Seiffge, D.J. Engelter, S. De Marchis, G.M. Polymeris, A. Zedde, M.L. Yaghi, S. Michel, P. Eskandari, A. Antonenko, K. Sohn, S.-I. Cappellari, M. Tassinari, T. Tassi, R. Masotti, L. Katsanos, A.H. Giannopoulos, S. Acciarresi, M. Alberti, A. Venti, M. Mosconi, M.G. Vedovati, M.C. Pierini, P. Giustozzi, M. Lotti, E.M. Ntaios, G. Kargiotis, O. Monaco, S. Lochner, P. Bandini, F. Liantinioti, C. Palaiodimou, L. Abdul-Rahim, A.H. Lees, K. Mancuso, M. Pantoni, L. Rosa, S. Bertora, P. Galliazzo, S. Ageno, W. Toso, E. Angelini, F. Chiti, A. Orlandi, G. Denti, L. Flomin, Y. Marcheselli, S. Mumoli, N. Rimoldi, A. Verrengia, E. Schirinzi, E. Del Sette, M. Papamichalis, P. Komnos, A. Popovic, N. Zarkov, M. Rocco, A. Diomedi, M. Giorli, E. Ciccone, A. Grory, B.C.M. Furie, K.L. Bonetti, B. Saia, V. Guideri, F. Acampa, M. Martini, G. Grifoni, E. Padroni, M. Karagkiozi, E. Perlepe, K. Makaritsis, K. Mannino, M. MacCarrone, M. Ulivi, L. Giannini, N. Ferrari, E. Pezzini, A. Doronin, B. Volodina, V. Baldi, A. D'Amore, C. Deleu, D. Corea, F. Putaala, J. Santalucia, P. Nardi, K. Risitano, A. Toni, D. Tsivgoulis, G.
Abstract: Background and Purpose-Despite treatment with oral anticoagulants, patients with nonvalvular atrial fibrillation (AF) may experience ischemic cerebrovascular events. The aims of this case-control study in patients with AF were to identify the pathogenesis of and the risk factors for cerebrovascular ischemic events occurring during non-Vitamin K antagonist oral anticoagulants (NOACs) therapy for stroke prevention. Methods-Cases were consecutive patients with AF who had acute cerebrovascular ischemic events during NOAC treatment. Controls were consecutive patients with AF who did not have cerebrovascular events during NOACs treatment. Results-Overall, 713 cases (641 ischemic strokes and 72 transient ischemic attacks; median age, 80.0 years; interquartile range, 12; median National Institutes of Health Stroke Scale on admission, 6.0; interquartile range, 10) and 700 controls (median age, 72.0 years; interquartile range, 8) were included in the study. Recurrent stroke was classified as cardioembolic in 455 cases (63.9%) according to the A-S-C-O-D (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; D, dissection) classification. On multivariable analysis, off-label low dose of NOACs (odds ratio [OR], 3.18; 95% CI, 1.95-5.85), atrial enlargement (OR, 6.64; 95% CI, 4.63-9.52), hyperlipidemia (OR, 2.40; 95% CI, 1.83-3.16), and CHA2DS2-VASc score (OR, 1.72 for each point increase; 95% CI, 1.58-1.88) were associated with ischemic events. Among the CHA2DS2-VASc components, age was older and presence of diabetes mellitus, congestive heart failure, and history of stroke or transient ischemic attack more common in patients who had acute cerebrovascular ischemic events. Paroxysmal AF was inversely associated with ischemic events (OR, 0.45; 95% CI, 0.33-0.61). Conclusions-In patients with AF treated with NOACs who had a cerebrovascular event, mostly but not exclusively of cardioembolic pathogenesis, off-label low dose, atrial enlargement, hyperlipidemia, and high CHA2DS2-VASc score were associated with increased risk of cerebrovascular events. © 2019 American Heart Association, Inc.
Published: 2019

28. Early haemostatic therapy for spontaneous intracranial haemorrhage

Author: Micieli, G., Tosi, P., Marcheselli, S., and Cavallini, A.
Published: 2005
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29. Autonomic dysfunction in Parkinson's disease

Author: Micieli, G., Tosi, P., Marcheselli, S., and Cavallini, A.
Published: 2003
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30. Migraine improvement after spontaneous cervical artery dissection the Italian Project on Stroke in Young Adults (IPSYS)

Author: De Giuli, V, Graziano, F, Zini, A, Zedde, M, Patella, R, Lodigiani, C, Marcheselli, S, Delodovici, M, Paciaroni, M, Casetta, I, Giorli, E, Adami, A, Braga, M, Casella, C, Giossi, A, Silvestrelli, G, Tancredi, L, Lotti, E, Poli, L, Caria, F, Piras, V, Cucurachi, L, Gamba, M, Grassi, M, Padovani, A, Pezzini, A, DeLodovici, ML, BRAGA, MASSIMILIANO, Lotti, EM, De Giuli, V, Graziano, F, Zini, A, Zedde, M, Patella, R, Lodigiani, C, Marcheselli, S, Delodovici, M, Paciaroni, M, Casetta, I, Giorli, E, Adami, A, Braga, M, Casella, C, Giossi, A, Silvestrelli, G, Tancredi, L, Lotti, E, Poli, L, Caria, F, Piras, V, Cucurachi, L, Gamba, M, Grassi, M, Padovani, A, Pezzini, A, DeLodovici, ML, BRAGA, MASSIMILIANO, and Lotti, EM
Abstract: Objective: Whether migraine modifies after spontaneous cervical artery dissection (sCeAD) more than after other stroke etiologic subtypes has never been adequately investigated. Methods: In the setting of the Italian Project on Stroke in Young Adults (IPSYS), we compared the course of migraine before and after acute brain infarct in a group of migraine patients with sCeAD and a group of migraine patients whose ischemia was due to a cause other than CeAD (non-CeAD IS), matched by sex, age (± 3 years), and migraine subtype.We applied linear mixed models to evaluate pre-event vs post-event changes and differences between sCeAD and non-CeAD IS patients. Results: Eighty-seven patients per group (migraine without aura/migraine with aura, 67/20) qualified for the analysis. After the acute event, migraine headaches disappeared in 14.0% of CeAD patients vs 0.0% of non-CeAD IS patients (p ≤ 0.001). Migraine frequency (patients suffering at least 1 attack, from 93.1 to 80.5%, p = 0.001), pain intensity (from 6.7 ± 1.7 to 4.6 ± 2.6 in a 0 to 10 pain scale, p ≤ 0.001), and use of acute anti-migraine medications (patients taking at least 1 preparation, from 81.6 to 64.4%, p = 0.007) also improved significantly after CeAD as opposed to that observed after non-CeAD IS. Conclusion: The spontaneous improvement of migraine after sCeAD reinforces the hypothesis of a pathogenic link between the two conditions
Published: 2019

31. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

Author: Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., Konda, D., Sallustio, F., Vallone, S., Zini, A., Bracco, S., Tassi, R., Bergui, M., Cerrato, P., Pitrone, A., Grillo, F., Saletti, A., De Vito, A., Gasparotti, Roberto, Magoni, M., Puglielli, E., Casalena, A., Causin, F., Baracchini, C., Castellan, L., Malfatto, L., Menozzi, R., Scoditti, U., Comelli, C., Duc, E., Comai, A., Franchini, E., Cosottini, M., Mancuso, M., Peschillo, S., De Michele, M., Giorgianni, A., Delodovici, M. L., Lafe, E., Denaro, M. F., Burdi, N., Interno, S., Cavasin, N., Critelli, A., Chiumarulo, L., Petruzzellis, M., Doddi, M., Carolei, A., Auteri, W., Petrone, A., Padolecchia, R., Tassinari, T., Pavia, M., Invernizzi, P., Turcato, G., Forlivesi, S., Ciceri, E. F. M., Bonetti, B., Inzitari, D., Toni D., Limbucci N, Consoli, A, Renieri, L, Fainardi, E, Gandini, R, Pampana, E, Diomedi, M, Koch, G, Verganti, L, Sacchetti, F, Zelent, G, Bigliardi, G, Picchetto, L, Vandelli, L, Romano, Dg, Cioni, S, Gennari, P, Cerase, A, Martini, G, Stura, G, Daniele, D, Naldi, A, Papa, R, Vinci, Sl, Bernava, G, Velo, M, Caragliano, A, Tessitore, A, Buonomo, O, Musolino, R, La Spina, P, Casella, C, Carolina Fazio, M, Cotroneo, M, Onofrio, M, Azzini, C, Casetta, I, Mardighian, D, Frigerio, M, Costa, A, Di Egidio, V, Lattanzi, R, Assetta, M, Cester, G, Mavilio, N, Serrati, C, Piazza, P, Epifani, E, Andreone, A, Castellini, P, Latte, L, Grisendi, I, Vaudano, G, Comelli, S, Cavallo, R, Chianale, G, Simonetti, L, Taglialatela, F, Isceri, S, Procaccianti, G, Zaniboni, A, Borghi, A, Bonatti, G, Ferro, F, Bonatti, M, Dall'Ora, E, Currò Dossi, R, Turri, E, Turri, M, Puglioli, M, Lazzarotti, G, Lauretti, D, Giannini, N, Maccarone, M, Orlandi, G, Chiti, A, Guidetti, G, Biraschi, F, Falcou, A, Anzini, A, Mancini, A, Fausti, S, Di Mascio, Mt, Durastanti, L, Sbardella, E, Mellina, V, Baruzzi, F, Pellegrino, C, Terrana, A, Carimati, F, Ruggiero, M, Sanna, A, Passarin, Mg, Colosimo, C, Pedicelli, A, D'Argento, F, Alexandre, A, Frisullo, G, Zappoli, F, Martignoni, A, Cavallini, A, Persico, A, Valvassori, L, Piano, M, Agostoni, E, Motto, C, Gatti, A, Longoni, M, Guccione, A, Tortorella, R, Zampieri, P, Zimatore, D, Grazioli, A, Ricciardi, Gk, Augelli, R, Bovi, P, Tomelleri, G, Micheletti, N, Semeraro, V, Lucarelli, N, Ganimede, M, Tinelli, A, Pia Prontera, M, Pesare, A, Cagliari, E, Quatrale, R, Federico, F, Passalacqua, G, Filauri, P, Orlandi, B, De Santis, F, Gabriele, A, Tiseo, C, Armentano, A, Di Benedetto, O, Silvagni, U, Perrotta, P, Crispino, E, Stancati, F, Rizzuto, S, Pugliese, P, Pisani, E, Siniscalchi, A, Gaudiano, C, Pirritano, D, Del Giudice, F, Calia, S, Ganci, G, Sugo, A, Scomazzoni, F, Simionato, F, Roveri, L, De Nicola, M, Giannoni, M, Bruni, S, Gambelli, E, Provinciali, L, Carriero, A, Coppo, L, Baldan, J, Paolo Nuzzi, N, Marcheselli, S, Corato, M, Cotroneo, E, Ricciardi, F, Gigli, R, Pozzessere, C, Pezzella, Fr, Corsi, F, Squassina, G, Cobelli, M, Morassi, M, Magni, Eugenio, Pepe, F, Bigni, B, Costa, P, Crabbio, M, Griffini, S, Palmerini, F, Piras, Mp, Natrella, M, Fanelli, G, Cristoferi, M, Bottacchi, E, Corso, G, Tosi, P, Amistà, P, Russo, M, Tettoni, S, Gallesio, I, Mascolo, Mc, Meloni, Gb, Fabio, C, Maiore, M, Pintus, F, Pischedda, A, Manca, A, Mongili, C, Zanda, B, Baule, A, Pappalardo, Mp, Craparo, G, Gallo, C, Monaco, S, Mannino, M, Terruso, V, Muto, M, Guarnieri, G, Andreone, V, Dui, G, Ticca, A, Salmaggi, A, Iannucci, G, Pinna, V, Di Clemente, L, Perini, F, De Boni, A, De Luca, C, De Giorgi, F, Corraine, S, Enne, P, Ganau, C, Piras, V., Gasparotti R., Magni E (ORCID:0000-0002-2235-2280), Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., Konda, D., Sallustio, F., Vallone, S., Zini, A., Bracco, S., Tassi, R., Bergui, M., Cerrato, P., Pitrone, A., Grillo, F., Saletti, A., De Vito, A., Gasparotti, Roberto, Magoni, M., Puglielli, E., Casalena, A., Causin, F., Baracchini, C., Castellan, L., Malfatto, L., Menozzi, R., Scoditti, U., Comelli, C., Duc, E., Comai, A., Franchini, E., Cosottini, M., Mancuso, M., Peschillo, S., De Michele, M., Giorgianni, A., Delodovici, M. L., Lafe, E., Denaro, M. F., Burdi, N., Interno, S., Cavasin, N., Critelli, A., Chiumarulo, L., Petruzzellis, M., Doddi, M., Carolei, A., Auteri, W., Petrone, A., Padolecchia, R., Tassinari, T., Pavia, M., Invernizzi, P., Turcato, G., Forlivesi, S., Ciceri, E. F. M., Bonetti, B., Inzitari, D., Toni D., Limbucci N, Consoli, A, Renieri, L, Fainardi, E, Gandini, R, Pampana, E, Diomedi, M, Koch, G, Verganti, L, Sacchetti, F, Zelent, G, Bigliardi, G, Picchetto, L, Vandelli, L, Romano, Dg, Cioni, S, Gennari, P, Cerase, A, Martini, G, Stura, G, Daniele, D, Naldi, A, Papa, R, Vinci, Sl, Bernava, G, Velo, M, Caragliano, A, Tessitore, A, Buonomo, O, Musolino, R, La Spina, P, Casella, C, Carolina Fazio, M, Cotroneo, M, Onofrio, M, Azzini, C, Casetta, I, Mardighian, D, Frigerio, M, Costa, A, Di Egidio, V, Lattanzi, R, Assetta, M, Cester, G, Mavilio, N, Serrati, C, Piazza, P, Epifani, E, Andreone, A, Castellini, P, Latte, L, Grisendi, I, Vaudano, G, Comelli, S, Cavallo, R, Chianale, G, Simonetti, L, Taglialatela, F, Isceri, S, Procaccianti, G, Zaniboni, A, Borghi, A, Bonatti, G, Ferro, F, Bonatti, M, Dall'Ora, E, Currò Dossi, R, Turri, E, Turri, M, Puglioli, M, Lazzarotti, G, Lauretti, D, Giannini, N, Maccarone, M, Orlandi, G, Chiti, A, Guidetti, G, Biraschi, F, Falcou, A, Anzini, A, Mancini, A, Fausti, S, Di Mascio, Mt, Durastanti, L, Sbardella, E, Mellina, V, Baruzzi, F, Pellegrino, C, Terrana, A, Carimati, F, Ruggiero, M, Sanna, A, Passarin, Mg, Colosimo, C, Pedicelli, A, D'Argento, F, Alexandre, A, Frisullo, G, Zappoli, F, Martignoni, A, Cavallini, A, Persico, A, Valvassori, L, Piano, M, Agostoni, E, Motto, C, Gatti, A, Longoni, M, Guccione, A, Tortorella, R, Zampieri, P, Zimatore, D, Grazioli, A, Ricciardi, Gk, Augelli, R, Bovi, P, Tomelleri, G, Micheletti, N, Semeraro, V, Lucarelli, N, Ganimede, M, Tinelli, A, Pia Prontera, M, Pesare, A, Cagliari, E, Quatrale, R, Federico, F, Passalacqua, G, Filauri, P, Orlandi, B, De Santis, F, Gabriele, A, Tiseo, C, Armentano, A, Di Benedetto, O, Silvagni, U, Perrotta, P, Crispino, E, Stancati, F, Rizzuto, S, Pugliese, P, Pisani, E, Siniscalchi, A, Gaudiano, C, Pirritano, D, Del Giudice, F, Calia, S, Ganci, G, Sugo, A, Scomazzoni, F, Simionato, F, Roveri, L, De Nicola, M, Giannoni, M, Bruni, S, Gambelli, E, Provinciali, L, Carriero, A, Coppo, L, Baldan, J, Paolo Nuzzi, N, Marcheselli, S, Corato, M, Cotroneo, E, Ricciardi, F, Gigli, R, Pozzessere, C, Pezzella, Fr, Corsi, F, Squassina, G, Cobelli, M, Morassi, M, Magni, Eugenio, Pepe, F, Bigni, B, Costa, P, Crabbio, M, Griffini, S, Palmerini, F, Piras, Mp, Natrella, M, Fanelli, G, Cristoferi, M, Bottacchi, E, Corso, G, Tosi, P, Amistà, P, Russo, M, Tettoni, S, Gallesio, I, Mascolo, Mc, Meloni, Gb, Fabio, C, Maiore, M, Pintus, F, Pischedda, A, Manca, A, Mongili, C, Zanda, B, Baule, A, Pappalardo, Mp, Craparo, G, Gallo, C, Monaco, S, Mannino, M, Terruso, V, Muto, M, Guarnieri, G, Andreone, V, Dui, G, Ticca, A, Salmaggi, A, Iannucci, G, Pinna, V, Di Clemente, L, Perini, F, De Boni, A, De Luca, C, De Giorgi, F, Corraine, S, Enne, P, Ganau, C, Piras, V., Gasparotti R., and Magni E (ORCID:0000-0002-2235-2280)
Abstract: Background and Purpose - As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set). Methods - We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve. Results - National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779). Conclusions - The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.
Published: 2019

32. Alcohol intake and the risk of intracerebral hemorrhage in the elderly: The MUCH-Italy

Author: Costa, P., Grassi, M., Iacoviello, L., Zedde, M., Marcheselli, S., Silvestrelli, G., Delodovici, M. L., Sessa, M., Zini, A., Paciaroni, M., Azzini, C., Gamba, M., Del Sette, M., Toriello, A., Gandolfo, C., Bonifati, D. M., Tassi, R., Cavallini, A., Chiti, A., Calabro, R. S., Grillo, F., Bovi, P., Tomelleri, G., Di Castelnuovo, A., Ritelli, M., Agnelli, G., De Vito, A., Pugliese, N., Martini, G., Lodigiani, C., Morotti, A., Poli, L., Degiuli, V., Caria, F., Cornali, C., Degaetano, G., Colombi, M., Padovani, A., Pezzini, A., D'Amore, C., Acciarresi, M., Caso, V., Alberti, A., Venti, M., Vandelli, L., Dell'Acqua, M. L., Simone, A. M., Nichelli, P. F., Lanari, A., Ciccone, A., Del Zotto, E., Gilberti, N., Magoni, M., Zucco, G., Massucco, D., Finocchi, C., Balestrino, M., Carletti, M., Zivelonghi, C., Casella, C., La Spina, P., Musolino, R., Bramanti, P., Princiotta Cariddi, L., Giorli, E., Strambo, D., Giacalone, G., Glielmi, A., Volpe, G., Micieli, G., Montano, V., Padroni, Marotta, G., Malferrari, G., Marcello, N., Cucurachi, L., and Giossi, A.
Subjects: Male, medicine.medical_specialty, Alcohol Drinking, Alcohol, Intracerebral hemorrhage, Elderly, 03 medical and health sciences, 0302 clinical medicine, Elderly, Risk Factors, Internal medicine, medicine, 80 and over, Humans, cardiovascular diseases, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, Cerebral Hemorrhage, Intracerebral hemorrhage, Aged, 80 and over, business.industry, Case-control study, Case-Control Studies, Female, Italy, Middle Aged, Self Report, Odds ratio, medicine.disease, Confidence interval, nervous system diseases, Cohort, Alcohol intake, Observational study, Neurology (clinical), business, Alcohol, 030217 neurology & neurosurgery
Abstract: ObjectiveTo investigate the role of alcohol as a causal factor for intracerebral hemorrhage (ICH) and whether its effects might vary according to the pathogenic mechanisms underlying cerebral bleeding.MethodsWe performed a case-control analysis, comparing a cohort of consecutive white patients with ICH aged 55 years and older with a group of age- and sex-matched stroke-free controls, enrolled in the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) between 2002 and 2014. Participants were dichotomized into excessive drinkers (>45 g of alcohol) and light to moderate drinkers or nondrinkers. To isolate the unconfounded effect of alcohol on ICH, we used causal directed acyclic graphs and the back-door criterion to select a minimal sufficient adjustment set(s) of variables for multivariable analyses. Analyses were performed on the whole group as well as separately for lobar and deep ICH.ResultsWe analyzed 3,173 patients (1,471 lobar ICH and 1,702 deep ICH) and 3,155 controls. After adjusting for the preselected variables in the minimal sufficient adjustments, heavy alcohol intake was associated with deep ICH risk (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.36–2.09) as well as with the overall risk of ICH (OR, 1.38; 95% CI, 1.17–1.63), whereas no effect was found for lobar ICH (OR, 1.01; 95% CI, 0.77–1.32).ConclusionsIn white people aged 55 years and older, high alcohol intake might exert a causal effect on ICH, with a prominent role in the vascular pathologies underlying deep ICH.
Published: 2018

33. Hemorrhagic transformation in patients with acute ischemic stroke and atrial fibrillation: Time to initiation of oral anticoagulant therapy and outcomes

Author: Paciaroni, M. Bandini, F. Agnelli, G. Tsivgoulis, G. Yaghi, S. Furie, K.L. Tadi, P. Becattini, C. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. D’Amore, C. Mosconi, M.G. Cimini, L.A. Altavilla, R. Volpi, G. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Masotti, L. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Liantinioti, C. Chondrogianni, M. Mumoli, N. Consoli, D. Galati, F. Sacco, S. Carolei, A. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Colombo, G. Silvestrelli, G. Ciccone, A. Lanari, A. Scoditti, U. Denti, L. Mancuso, M. Maccarrone, M. Ulivi, L. Orlandi, G. Giannini, N. Gialdini, G. Tassinari, T. De Lodovici, M.L. Bono, G. Rueckert, C. Baldi, A. D'Anna, S. Toni, D. Letteri, F. Giuntini, M. Lotti, E.M. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Pallesen, L.-P. Barlinn, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Caso, V.
Abstract: Background—In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results—HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3-8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0-6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24-2.35). Conclusions—In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability. © 2018 The Authors.
Published: 2018

34. The role of clinical and neuroimaging features in the diagnosis of CADASIL

Author: Bersano, A, Bedini, G, Markus, H, Vitali, P, Colli-Tibaldi, E, Taroni, F, Gellera, C, Baratta, S, Mosca, L, Carrera, P, Ferrari, M, Cereda, C, Grieco, G, Lanfranconi, S, Mazucchelli, F, Zarcone, D, De Lodovici, M, Bono, G, Boncoraglio, G, Parati, E, Calloni, M, Perrone, P, Bordo, B, Motto, C, Agostoni, E, Pezzini, A, Padovani, A, Micieli, G, Cavallini, A, Molini, G, Sasanelli, F, Sessa, M, Comi, G, Checcarelli, N, Carmerlingo, M, Corato, M, Marcheselli, S, Fusi, L, Grampa, G, Uccellini, D, Beretta, S, Ferrarese, C, Incorvaia, B, Tadeo, C, Adobbati, L, Silani, V, Faragò, G, Trobia, N, Grond-Ginsbach, C, Candelise, L, Mazzucchelli, F, Guidotti, M, Riva, M, Iurlaro, S, Maria, B, Braga, M, Meola, G, Carpo, M, Camerlingo, M, Borutti, G, Delodovici, M, Verrengia, E, Tancredi, L, Terruzzi, A, Magoni, M, Del Zotto, E, Bassi, P, Lattuada, P, Ballabio, E, Gambaro, P, Corrà, B, Canavero, I, Arbustini, E, Grasso, M, Corti, S, Ronchi, D, Merlini, G, Obici, L, Bassi, M, Tagliavini, F, Ginsbach, C, Bersano, Anna, BEDINI, GLORIA, Markus, Hugh Stephen, Vitali, Paolo, Colli-Tibaldi, Enrico, Taroni, Franco, Gellera, Cinzia, Baratta, Silvia, Mosca, Lorena, Carrera, Paola, FERRARI, MAURIZIO, Cereda, Cristina, Grieco, Gaetano, Lanfranconi, Silvia, Mazucchelli, Franca, Zarcone, Davide, De Lodovici, Maria Luisa, Bono, Giorgio, Boncoraglio, Giorgio Battista, Parati, Eugenio Agostino, Calloni, Maria Vittoria, Perrone, Patrizia, Bordo, Bianca Maria, Motto, Cristina, Agostoni, Elio, Pezzini, Alessandro, Padovani, Alessandro, Micieli, Giuseppe, Cavallini, Anna, Molini, Graziella, Sasanelli, Francesco, Sessa, Maria, Comi, Giancarlo, Checcarelli, Nicoletta, Carmerlingo, Massimo, CORATO, MANUEL, Marcheselli, Simona, Fusi, Laura, Grampa, Giampiero, Uccellini, Davide, Beretta, Simone, Ferrarese, Carlo, Incorvaia, Barbara, Tadeo, Carlo Sebastiano, Adobbati, Laura, Silani, Vincenzo, Faragò, Giuseppe, Trobia, Nadia, Grond-Ginsbach, Caspar, Candelise, Livia, Mazzucchelli, Franca, Guidotti, Mario, Riva, Maurizio, Iurlaro, Simona, Maria, Bianca Bordo, Braga, Massimiliano, Meola, Giovanni, Carpo, Marinella, Camerlingo, Massimo, Borutti, Giuseppina, Delodovici, Marialuisa, Verrengia, Elena Pinuccia, Tancredi, Lucia, Terruzzi, Alessandro, Magoni, Mauro, Del Zotto, Elisabetta, Bassi, Pietro, Lattuada, Patrizia, Ballabio, Elena, Gambaro, Paola, Lanfranconi, Sivia, Corrà, Barbara, Canavero, Isabella, Arbustini, Eloisa, Grasso, Maurizia, Comi, Giacomo Pietro, Corti, Stefania, Ronchi, Dario, Merlini, Giampaolo, Obici, Laura, Bassi, Maria Teresa, Tagliavini, Fabrizio, Ginsbach, Caspar Grond, Bersano, A, Bedini, G, Markus, H, Vitali, P, Colli-Tibaldi, E, Taroni, F, Gellera, C, Baratta, S, Mosca, L, Carrera, P, Ferrari, M, Cereda, C, Grieco, G, Lanfranconi, S, Mazucchelli, F, Zarcone, D, De Lodovici, M, Bono, G, Boncoraglio, G, Parati, E, Calloni, M, Perrone, P, Bordo, B, Motto, C, Agostoni, E, Pezzini, A, Padovani, A, Micieli, G, Cavallini, A, Molini, G, Sasanelli, F, Sessa, M, Comi, G, Checcarelli, N, Carmerlingo, M, Corato, M, Marcheselli, S, Fusi, L, Grampa, G, Uccellini, D, Beretta, S, Ferrarese, C, Incorvaia, B, Tadeo, C, Adobbati, L, Silani, V, Faragò, G, Trobia, N, Grond-Ginsbach, C, Candelise, L, Mazzucchelli, F, Guidotti, M, Riva, M, Iurlaro, S, Maria, B, Braga, M, Meola, G, Carpo, M, Camerlingo, M, Borutti, G, Delodovici, M, Verrengia, E, Tancredi, L, Terruzzi, A, Magoni, M, Del Zotto, E, Bassi, P, Lattuada, P, Ballabio, E, Gambaro, P, Corrà, B, Canavero, I, Arbustini, E, Grasso, M, Corti, S, Ronchi, D, Merlini, G, Obici, L, Bassi, M, Tagliavini, F, Ginsbach, C, Bersano, Anna, BEDINI, GLORIA, Markus, Hugh Stephen, Vitali, Paolo, Colli-Tibaldi, Enrico, Taroni, Franco, Gellera, Cinzia, Baratta, Silvia, Mosca, Lorena, Carrera, Paola, FERRARI, MAURIZIO, Cereda, Cristina, Grieco, Gaetano, Lanfranconi, Silvia, Mazucchelli, Franca, Zarcone, Davide, De Lodovici, Maria Luisa, Bono, Giorgio, Boncoraglio, Giorgio Battista, Parati, Eugenio Agostino, Calloni, Maria Vittoria, Perrone, Patrizia, Bordo, Bianca Maria, Motto, Cristina, Agostoni, Elio, Pezzini, Alessandro, Padovani, Alessandro, Micieli, Giuseppe, Cavallini, Anna, Molini, Graziella, Sasanelli, Francesco, Sessa, Maria, Comi, Giancarlo, Checcarelli, Nicoletta, Carmerlingo, Massimo, CORATO, MANUEL, Marcheselli, Simona, Fusi, Laura, Grampa, Giampiero, Uccellini, Davide, Beretta, Simone, Ferrarese, Carlo, Incorvaia, Barbara, Tadeo, Carlo Sebastiano, Adobbati, Laura, Silani, Vincenzo, Faragò, Giuseppe, Trobia, Nadia, Grond-Ginsbach, Caspar, Candelise, Livia, Mazzucchelli, Franca, Guidotti, Mario, Riva, Maurizio, Iurlaro, Simona, Maria, Bianca Bordo, Braga, Massimiliano, Meola, Giovanni, Carpo, Marinella, Camerlingo, Massimo, Borutti, Giuseppina, Delodovici, Marialuisa, Verrengia, Elena Pinuccia, Tancredi, Lucia, Terruzzi, Alessandro, Magoni, Mauro, Del Zotto, Elisabetta, Bassi, Pietro, Lattuada, Patrizia, Ballabio, Elena, Gambaro, Paola, Lanfranconi, Sivia, Corrà, Barbara, Canavero, Isabella, Arbustini, Eloisa, Grasso, Maurizia, Comi, Giacomo Pietro, Corti, Stefania, Ronchi, Dario, Merlini, Giampaolo, Obici, Laura, Bassi, Maria Teresa, Tagliavini, Fabrizio, and Ginsbach, Caspar Grond
Abstract: Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common familial cerebral small vessel disease, caused by NOTCH3 gene mutations. The aim of our study was to identify clinical and neuroradiological features which would be useful in identifying which patients presenting with lacunar stroke and TIA are likely to have CADASIL. Methods: Patients with lacunar stroke or TIA were included in the present study. For each patient, demographic and clinical data were collected. MRI images were centrally analysed for the presence of lacunar infarcts, microbleeds, temporal lobe involvement, global atrophy and white matter hyperintensities. Results: 128 patients (mean age 56.3 ± 12.4 years) were included. A NOTCH3 mutation was found in 12.5% of them. A family history of stroke, the presence of dementia and external capsule lesions on MRI were the only features significantly associated with the diagnosis of CADASIL. Although thalamic, temporal pole gliosis and severe white matter hyperintensities were less specific for CADASIL diagnosis, the combination of a number of these factors together with familial history for stroke result in a higher positive predictive value and specificity. Conclusions: A careful familial history collection and neuroradiological assessment can identify patients in whom NOTCH3 genetic testing has a higher yield.
Published: 2018

35. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Author: Paciaroni, M. Agnelli, G. Caso, V. Tsivgoulis, G. Furie, K.L. Tadi, P. Becattini, C. Falocci, N. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. D'Amore, C. Mosconi, M.G. Cimini, L.A. Procopio, A. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Bandini, F. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Masotti, L. Vannucchi, V. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Karagkiozi, E. Athanasakis, G. Makaritsis, K. Vadikolias, K. Liantinioti, C. Chondrogianni, M. Mumoli, N. Consoli, D. Galati, F. Sacco, S. Carolei, A. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Colombo, G. Silvestrelli, G. Ciccone, A. Scoditti, U. Denti, L. Mancuso, M. Maccarrone, M. Orlandi, G. Giannini, N. Gialdini, G. Tassinari, T. De Lodovici, M.L. Bono, G. Rueckert, C. Baldi, A. D'Anna, S. Toni, D. Letteri, F. Giuntini, M. Lotti, E.M. Flomin, Y. Pieroni, A. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Pallesen, L.-P. Kepplinger, J. Bodechtel, U. Gerber, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Yaghi, S.
Abstract: Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.
Published: 2017

36. Early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with Non-Vitamin-K oral anticoagulants (RAF-NOACs) Study

Author: Paciaroni, M. Agnelli, G. Falocci, N. Tsivgoulis, G. Vadikolias, K. Liantinioti, C. Chondrogianni, M. Bovi, P. Carletti, M. Cappellari, M. Zedde, M. Ntaios, G. Karagkiozi, E. Athanasakis, G. Makaritsis, K. Silvestrelli, G. Lanari, A. Ciccone, A. Putaala, J. Tomppo, L. Tatlisumak, T. Abdul-Rahim, A.H. Lees, K.R. Alberti, A. Venti, M. Acciarresi, M. D'Amore, C. Becattini, C. Mosconi, M.G. Cimini, L.A. Soloperto, R. Masotti, L. Vannucchi, V. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Sohn, S.-I. Marcheselli, S. Mumoli, N. De Lodovici, M.L. Bono, G. Furie, K.L. Tadi, P. Yaghi, S. Toni, D. Letteri, F. Tassinari, T. Kargiotis, O. Lotti, E.M. Flomin, Y. Mancuso, M. Maccarrone, M. Giannini, N. Bandini, F. Pezzini, A. Poli, L. Padovani, A. Scoditti, U. Denti, L. Consoli, D. Galati, F. Sacco, S. Carolei, A. Tiseo, C. Gourbali, V. Orlandi, G. Giuntini, M. Chiti, A. Giorli, E. Gialdini, G. Corea, F. Ageno, W. Bellesini, M. Colombo, G. Monaco, S. Baronello, M.M. Karapanayiotides, T. Caso, V.
Abstract: Background--The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within90 days)and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention. Methods and Results--Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2-VASc score > 4 and less reduced renal function. Thirty-two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated > 14 days after acute stroke. Conclusions--In patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days. © 2017 The Authors.
Published: 2017

37. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: results from the RAF-study (Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Author: Antonenko, K, Paciaroni, M, Agnelli, G, Falocci, N, Becattini, C, Marcheselli, S, Rueckert, C, Pezzini, A, Poli, L, Padovani, A, Csiba, L, Szabó, L, Sohn, Si, Tassinari, T, Abdul Rahim, A, Michel, P, Cordier, M, Vanacker, P, Remillard, S, Alberti, A, Venti, M, Acciarresi, M, D’Amore, C, Scoditti, U, Denti, L, Orlandi, G, Chiti, A, Gialdini, G, Bovi, P, Carletti, M, Rigatelli, A, Putaala, J, Tatlisumak, T, Masotti, L, Lorenzini, G, Tassi, R, Guideri, F, Martini, G, Tsivgoulis, G, Vadikolias, K, Papageorgiou, Sg, Corea, F, Del Sette, M, Ageno, W, De Lodovici, Ml, Bono, G, Baldi, A, D’Anna, S, Sacco, Simona, Carolei, A, Tiseo, C, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Consoli, D, Galati, F, Pieroni, A, Toni, D, Monaco, S, Maimone Baronello, M, Barlinn, K, Pallesen, Lp, Kepplinger, J, Bodechtel, U, Gerber, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Mosconi, Mg, Lees, Kr, and Caso, V.
Published: 2017

38. Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

Author: Acciarresi, M. Paciaroni, M. Agnelli, G. Falocci, N. Caso, V. Becattini, C. Marcheselli, S. Rueckert, C. Pezzini, A. Morotti, A. Costa, P. Padovani, A. Csiba, L. Szabó, L. Sohn, S.-I. Tassinari, T. Abdul-Rahim, A.H. Michel, P. Cordier, M. Vanacker, P. Remillard, S. Alberti, A. Venti, M. D'Amore, C. Scoditti, U. Denti, L. Orlandi, G. Chiti, A. Gialdini, G. Bovi, P. Carletti, M. Rigatelli, A. Putaala, J. Tatlisumak, T. Masotti, L. Lorenzini, G. Tassi, R. Guideri, F. Martini, G. Tsivgoulis, G. Vadikolias, K. Liantinioti, C. Corea, F. Del Sette, M. Ageno, W. De Lodovici, M.L. Bono, G. Baldi, A. D'Anna, S. Sacco, S. Carolei, A. Tiseo, C. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Consoli, D. Galati, F. Pieroni, A. Toni, D. Monaco, S. Baronello, M.M. Barlinn, K. Pallesen, L.-P. Kepplinger, J. Bodechtel, U. Gerber, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Mosconi, M.G. Lees, K.R.
Subjects: cardiovascular diseases
Abstract: Background and Purpose The aim of this study was to investigate for a possible association between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF). Methods This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS
Published: 2017

39. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Author: Antonenko, K. Paciaroni, M. Agnelli, G. Falocci, N. Becattini, C. Marcheselli, S. Rueckert, C. Pezzini, A. Poli, L. Padovani, A. Csiba, L. Szabó, L. Sohn, S.-I. Tassinari, T. Abdul-Rahim, A.H. Michel, P. Cordier, M. Vanacker, P. Remillard, S. Alberti, A. Venti, M. Acciarresi, M. D’Amore, C. Scoditti, U. Denti, L. Orlandi, G. Chiti, A. Gialdini, G. Bovi, P. Carletti, M. Rigatelli, A. Putaala, J. Tatlisumak, T. Masotti, L. Lorenzini, G. Tassi, R. Guideri, F. Martini, G. Tsivgoulis, G. Vadikolias, K. Papageorgiou, S.G. Corea, F. Sette, M.D. Ageno, W. Lodovici, M.L.D. Bono, G. Baldi, A. D’Anna, S. Sacco, S. Carolei, A. Tiseo, C. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Consoli, D. Galati, F. Pieroni, A. Toni, D. Monaco, S. Baronello, M.M. Barlinn, K. Pallesen, L.-P. Kepplinger, J. Bodechtel, U. Gerber, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Mosconi, M.G. Lees, K.R. Caso, V.
Subjects: cardiovascular diseases
Abstract: Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes. Methods: Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome). Results: Of the 1029 patients enrolled, 561 were women (54.5%) (p < 0.001) and younger (p < 0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke (p = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, p = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, p < 0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men (p = 0.28 and p = 0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men (p < 0.001). Multivariate analysis did not confirm this significance. Conclusions: Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes. © 2016, © European Stroke Organisation 2016.
Published: 2017

40. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Author: Paciaroni, M. Agnelli, G. Falocci, N. Caso, V. Becattini, C. Marcheselli, S. Rueckert, C. Pezzini, A. Poli, L. Padovani, A. Csiba, L. Szabó, L. Sohn, S.-I. Tassinari, T. Abdul-Rahim, A.H. Michel, P. Cordier, M. Vanacker, P. Remillard, S. Alberti, A. Venti, M. Acciarresi, M. D’Amore, C. Mosconi, M.G. Scoditti, U. Denti, L. Orlandi, G. Chiti, A. Gialdini, G. Bovi, P. Carletti, M. Rigatelli, A. Putaala, J. Tatlisumak, T. Masotti, L. Lorenzini, G. Tassi, R. Guideri, F. Martini, G. Tsivgoulis, G. Vadikolias, K. Liantinioti, C. Corea, F. Del Sette, M. Ageno, W. De Lodovici, M.L. Bono, G. Baldi, A. D’Anna, S. Sacco, S. Carolei, A. Tiseo, C. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Consoli, D. Galati, F. Pieroni, A. Toni, D. Monaco, S. Baronello, M.M. Barlinn, K. Pallesen, L.-P. Kepplinger, J. Bodechtel, U. Gerber, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Lees, K.R.
Subjects: cardiovascular diseases
Abstract: Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). The identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon. © 2015, Springer-Verlag Berlin Heidelberg.
Published: 2016

41. Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: Effect of anticoagulation and its timing: The RAF study

Author: Paciaroni, M. Agnelli, G. Falocci, N. Caso, V. Becattini, C. Marcheselli, S. Rueckert, C. Pezzini, A. Poli, L. Padovani, A. Csiba, L. Szabó, L. Sohn, S.-I. Tassinari, T. Abdul-Rahim, A.H. Michel, P. Cordier, M. Vanacker, P. Remillard, S. Alberti, A. Venti, M. Scoditti, U. Denti, L. Orlandi, G. Chiti, A. Gialdini, G. Bovi, P. Carletti, M. Rigatelli, A. Putaala, J. Tatlisumak, T. Masotti, L. Lorenzini, G. Tassi, R. Guideri, F. Martini, G. Tsivgoulis, G. Vadikolias, K. Liantinioti, C. Corea, F. Del Sette, M. Ageno, W. De Lodovici, M.L. Bono, G. Baldi, A. D'Anna, S. Sacco, S. Carolei, A. Tiseo, C. Acciarresi, M. D'Amore, C. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Consoli, D. Galati, F. Pieroni, A. Toni, D. Monaco, S. Baronello, M.M. Barlinn, K. Pallesen, L.-P. Kepplinger, J. Bodechtel, U. Gerber, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Mosconi, M.G. Bubba, V. Silvestri, I. Lees, K.R.
Abstract: Background and Purpose - The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. Methods - The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Results - Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). Conclusions - Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants. © 2015 American Heart Association, Inc.
Published: 2015

42. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study

Author: Paciaroni, M. Inzitari, D. Agnelli, G. Caso, V. Balucani, C. Grotta, J.C. Sarraj, A. Sung-Il, S. Chamorro, A. Urra, X. Leys, D. Henon, H. Cordonnier, C. Dequatre, N. Aguettaz, P. Alberti, A. Venti, M. Acciarresi, M. D’Amore, C. Zini, A. Vallone, S. Dell’Acqua, M.L. Menetti, F. Nencini, P. Mangiafico, S. Barlinn, K. Kepplinger, J. Bodechtel, U. Gerber, J. Bovi, P. Cappellari, M. Linfante, I. Dabus, G. Marcheselli, S. Pezzini, A. Padovani, A. Alexandrov, A.V. Shahripour, R.B. Sessa, M. Giacalone, G. Silvestrelli, G. Lanari, A. Ciccone, A. De Vito, A. Azzini, C. Saletti, A. Fainardi, E. Orlandi, G. Chiti, A. Gialdini, G. Silvestrini, M. Ferrarese, C. Beretta, S. Tassi, R. Martini, G. Tsivgoulis, G. Vasdekis, S.N. Consoli, D. Baldi, A. D’Anna, S. Luda, E. Varbella, F. Galletti, G. Invernizzi, P. Donati, E. De Lodovici, M.L. Bono, G. Corea, F. Sette, M.D. Monaco, S. Riva, M. Tassinari, T. Scoditti, U. Toni, D.
Abstract: The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0–2) or unfavourable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88–1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40–0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5–6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86–1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00–3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed. © 2014, Springer-Verlag Berlin Heidelberg.
Published: 2015

43. Determinants of premature familial arterial thrombosis in patient with Juvenile ischaemic stroke. The Italian Project on Stroke in Young Adults ( IPSYS)

Author: Pezzini, A, Grassi, M, Lodigiani, C, Patella, Rosalba, Gandolfo, C, Zini, A, Delodovici, Ml, Paciaroni, M, Del Sette, M, Toriello, A, Musolino, R, Calabrò, Rs, Bovi, P, Adami, A, Silvestrelli, G, Sessa, M, Cavallini, A, Marcheselli, S, Bonifati, Dm, Checcarelli, N, Tancredi, L, Chiti, A, Del Zotto, E, Spalloni, A, Costa, P, Giacalone, G, Ferrazzi, P, Poli, L, Morotti, A, Rasura, Maurizia, Simone, Am, Gamba, M, Cerrato, P, Micieli, G, Melis, M, Massucco, D, De Giuli, V, Pepe, D, Iacoviello, L, Padovani, A, and on behalf of the Italian Project on Stroke in Young Adults Investigators
Subjects: Male, Familial aggregation, Pediatrics, Heredity, Time Factors, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Stroke in young adults, Recurrence, Risk Factors, Odds Ratio, Myocardial infarction, Age of Onset, Young adult, Family history, Stroke, Smoking, Family aggregation, Hematology, Middle Aged, Prognosis, Thrombosis, Phenotype, Italy, Antibodies, Antiphospholipid, Cohort studies, Female, Prothrombin, Cohort study, Adult, medicine.medical_specialty, Adolescent, Arterial Occlusive Diseases, Young Adult, 03 medical and health sciences, Risk factors in epidemiology, medicine, Humans, juvenile stroke, Juvenile, Genetic Predisposition to Disease, Blood Coagulation, Proportional Hazards Models, Chi-Square Distribution, business.industry, Factor V, medicine.disease, Logistic Models, Multivariate Analysis, Mutation, Physical therapy, business, Biomarkers, 030217 neurology & neurosurgery
Abstract: SummaryFactors predicting family history (FH) of premature arterial thrombosis in young patients with ischaemic stroke (IS) have not been extensively investigated, and whether they might influence the risk of post-stroke recurrence is still unknown. In the present study we analysed 1,881 consecutive first-ever IS patients aged 18–45 years recruited from January 2000 to January 2012 as part of the Italian Project on Stroke in Young Adults (IPSYS). FH of premature arterial thrombosis was any thrombotic event [IS, myocardial infarction or other arterial events event] > 45 years in proband’s first-degree relatives. Compared with patients without FH of premature arterial thrombosis, those with FH (n= 85) were more often smokers (odds ratio [OR], 1.94; 95 % confidence interval [CI], 1.21–3.09) and carriers of procoagulant abnormalities (OR, 3.66; 95 % CI, 2.21–6.06). Smoking (OR, 2.48; 95 % CI, 1.20–5.15), the A1691 mutation in factor V gene (OR, 3.64; 95 % CI, 1.31–10.10), and the A20210 mutation in the prothrombin gene (OR, 8.40; 95 % CI 3.35–21.05) were associated with FH of premature stroke (n = 33), while circulating anti-phospholipids to FH of premature myocardial infarction (n = 45; OR, 3.48; 95 % CI, 1.61–7.51). Mean follow-up time was 46.6 ± 38.6 months. Recurrent events occurred more frequently in the subgroup of patients with FH of premature stroke [19.4 %); p = 0.051] compared to patients without such a FH. In conclusion, young IS patients with FH of premature arterial thrombosis exhibit a distinct risk-factor profile, an underlying procoagulant state and have worse vascular prognosis than those with no FH of juvenile thrombotic events.
Published: 2015

44. Vorapaxar in the secondary prevention of atherothrombotic events

Author: Braunwald E, Morrow DA, Scirica BM, Bonaca MP, McCabe CH, Morin S, Fish P, Lamp J, Gershman E, Murphy S, Deenadayalu N, Skene A, Hill K, Bennett L, Strony J, Plat F, Berman G, Lipka L, Kilian A, He W, Liu X, Fox KA, Aylward P, Bassand JP, Betriu A, Bounameaux H, Corbalan R, Creager M, Dalby A, De Ferrari G, Dellborg M, Diehm CH, Dietz R, Goto S, Grande P, Gurbel P, Hankey G, Isaza D, Jensen P, Kiss R, Lewis B, Merlini P, Moliterno D, Morais J, Nicolau JC, Nieminen M, Nilsen D, Olin J, Ophuis TO, Paolasso E, Pichler M, Shinohara Y, Spinar J, Teal P, Tendera M, Theroux P, Thomassen L, Van de Werf F, White H, Wilcox R, Alberts M, Ameriso S, Diener H, Mohr J, Welch M, Wiviott SD, Awtry E, Berger C, Desai A, Gelfand E, Ho C, Leeman D, Link M, Norden A, Pande A, Rost N, Ruberg R, Silverman S, Singhal A, Vita J, Frye RL, Bailey KR, Easton J, Hochman J, Steg PG, Verheught F, Lee K, Mauro DO, Centurion A, Carlevaro O, Cardozo E, Cartasegna L, Soccini N, Farras HA, Molina Aguirre E, Duronto E, Arrechavala L, Rey R, Stilman A, Fernández H, Marinsalta G, Tartaglione J, Chekherdemian M, Povedano G, Casares E, Kantor P, Reges P, Cuneo C, Martinez G, MacKinnon I, Bagnato B, Fernandez A, Funosas C, Lozada A, Barilati P, Ferrari J, Ferrari N, Llanos J, Casaccia G, Giannaula R, García Méndez C, Cirio J, García Dávila C, Estol C, Chiezzo D, Ramirez J, Garrido S, López M, Hominal M, Bianchini MV, Ramos M, Verdini E, Herrera G, Monne H, Ioli P, Samudio MA, Rotta Escalante R, Tarulla A, Reich E, Perez G, Milesi R, Berli M, Marino J, Funes I, Prado A, Bezi M, Fernandez R, Rojas M, Cimbaro Canella JP, Galarza Salazan M, Chew D, Horsfall L, Claxton A, French J, O'Brien K, Nelson G, Loxton A, McCann A, Downey C, Aroney C, Cleave P, Worthley S, Roach A, Amerena J, Long A, Thompson P, Ferguson L, Fitzpatrick M, Mackenzie M, Youssef G, Goldsmith H, Jayasinghe R, Quinlan S, Arstall M, Rose J, Counsell J, Martin M, Crimmins D, Slattery A, Anderson C, Paraskevaidis T, Davis S, Silver G, Gerraty RP, Gapper J, Donnan G, Petrolo S, Whelan A, Tulloch G, Singh B, Campo Ma, Dick R, Savage C, Hill A, Conway B, Waites J, Keays P, Kopp K, Hainzer D, Podczeck Schweighofer A, Priesnitz T, Drexel H, Hagspiel V, Foeger B, Hilbe C, Trinka E, Sinadinoska D, Pilger E, Brodmann M, Stöllberger C, Jungbauer LV, Koppensteiner R, Hoke M, Grisold W, Berger O, Gaul GB, Fazekas N, Wandaller C, Stockenhuber F, Rek A, Willeit J, Zangerle A, Kiechl S, Sturm W, Theurl M, Gruber F, Schacherl S, Auer J, Primus C, Eber B, Ammer M, Hofer JF, Mayr H, Moser S, Hoellmueller I, Van der Werf F, Motte S, Jorion M, Schroë H, Zwinnen W, Vermassen F, Geenens M, De Wolf L, Briké C, De Deyn P, Ongena P, De Klippel N, Meeuwissen K, Desfontaines P, Tincani G, Vandermeeren Y, de Fays K, Pandolfo M, Alaerts N, Peeters A, Findik A, Tack P, deGrande E, Thijs V, Marcelis E, Van Landegem W, Vanhagendoren S, Vanhooren G, Schotte V, Celen H, Bes N, De Letter J, Holvoet G, Claerbout B, Verhamme P, Debaveye B, Bourgeois P, Debrabandere K, Stalpaert S, Dhondt E, De Maeseneire S, De Bleecker J, de Koning K, Vincent M, Tahon S, Monté C, Maes J, Vossaert R, Vandenhoven C, Roosen J, Vissers C, Sinnaeve P, de Velder L, Thoeng J, Cauwenberghs J, Deceuninck F, Nicolau J, Ardito WR, Queirantes C, de Araujo Filho JD, Queirantes CS, Ribeiro JP, Guizzardi SP, Chaves ML, Titton NF, Pereira AH, Webber I, da Silva DG Jr, Uehara RM, Brasileiro J, Maia LN, Souza A, Bodanese LC, Homem R, Friedrich MA, Macagnan AP, Dutra OP, Brum AB, Rossi PR, Herek L, Feitosa GS, Bernardes Ade S, Braga J, Rodrigues D, Guimarães A, Teixeira AB, Marin Neto JA, Tonani M, Piegas LS, Amato V, Leães P, Osorio RL, Ganem F, Vieira AP, Leao P, Kanashiro V, Franken RA, Martins EP, Gagliardi RJ, Silva L, Caffaro RA, Novaes GS, Carvalho A, Laet VL, Miranda F. 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Schlesinger, A, Munevar, V, Rodriguez, J, Granados, Lm, Jaramillo, N, Aristizabal, C, Cano, N, Salazar, Jc, Urina, M, Manco, T, Valenzuela, C, Hernandez, Hj, Delgado, P, Vagner, B, Castaño, La, Ucros, P, Tellez, M, Delgado, Ja, Piedrahita, Ca, Crump, J, Fernandez, V, Quintero, Ca, Moreno, M, Hernandez Triana, E, Cuentas, I, Accini, Jl, Accini, M, Manzur, F, Rivera, E, Reynales, H, Huertas, D, Hovorka, J, Filipovsky, J, Hirmerova, J, Peska, S, Jura, R, Kanovsky, P, Herzig, R, Jansky, P, Fiala, R, Kalita, Z, Gatkova, A, Bauer, J, Fiksa, J, Sedlacek, J, Monhart, Z, Bren, J, Linhart, A, Skalicka, L, Vitovec, J, Hlinomaz, O, Parenica, J, Soucek, M, Rihacek, I, Branny, M, Sknouril, L, Klimsa, Z, Holub, M, Línkova, H, Rektor, I, Mikulik, R, Mayer O., Sr, Novakova, B, Bar, M, Brodova, P, Polasek, R, Sabl, P, Kos, P, Lorenc, Z, Macel, I, Graversen, Kh, Galatius, S, Soderberg, Lh, Sillesen, H, Madelung, S, Overgård, K, Stan, V, Rasmussen, Lh, Mortensen, B, Iversen, Hk, Back, C, Olesen, C, Christensen, H, Pedersen, A, Nielsen, T, Hasain, M, Tanggaard, L, Husted, S, Christensen, Ll, Haas, L, Mickley, H, Hosbond, S, Rosenlund, I, Jepsen, J, Kaspersen, Bb, Bronnum Schou, J, Hempel, H, Nyvad, O, Feldthaus, B, Jensen, B, Jensen, Mk, Andersen, G, Thomsen, Rb, Rokkedal, J, Joergensen, A, Bülow, M, Jeppesen, J, Lederballe, O, Scheibel, I, Sjol, A, Larsen, J, Graner, M, Svahn, T, Melin, J, Kaakkomäki, A, Airaksinen, J, Vasankari, T, Tatlisumak, T, Metso, M, Remes, A, Näppä, M, Jäkälä, P, Sivenius, J, Kalinen, M, Roine, Ro, Ketola, R, Bassand, J, Pales, D, Coisne, D, Berger, N, Galinier, M, Rosolin, N, Elbaz, M, Lacassagne, L, Montalescot, G, Vignolles, N, Gully, C, Lepage, I, Roynard, J, Hamon, M, Brucato, S, Macquin Mavier, I, Beitar, T, Berthezene, P, Medkour, T, Amarenco, P, Gueblaoui, N, Timsit, S, Riou, D, Mahagne, M, Suissa, L, Quere, I, Clouzot, S, Emmerich, J, Martinez, I, Moulin, T, Cole, M, Hosseini, H, Monod, V, Cottin, Y, Bichat, F, Galley, D, Beltra, C, Samson, Y, Pires, R, Bura Riviere, A, Pelvet, B, Giroud, M, Lecheneaut, C, Ohlmann, P, Ait m., bark Z, Farah, B, Petit, F, Caussin, C, Braun, C, Diehm, C, Mehrhof, F, Inkrot, S, Darius, H, Heinze, H, Radke, P, Kulikowsky, C, Ferrari, M, Utschig, S, Strasser, R, Haacke, K, Felix, Sb, Bruder, M, Nienaber, C, Pfaff, H, Sohn, H, Baylacher, M, Mudra, H, Setzer, P, Konstantinides, S, Hallmann, A, Kreuzer, J, Tsoy, I, Schneider, P, Appel, Kf, Habermeier, A, Zeiher, Am, Kretschmer, T, Mitrovic, V, Lehinant, S, Bohlscheid, V, Palme, B, Heuer, H, Espinola Klein, C, Savvidis, S, Kleinertz, K, Hänel, J, Schmidt, E, Schmidt, A, Ringleb, Pa, Ludwig, I, Dietzold, M, Schaffranka, A, Ranft, J, Cegla, C, Berrouschot, J, Stoll, A, Tanislav, C, Brandtner, Ma, Rosenkranz, M, Otto, D, Görtler, M, Barleben, M, Haberl, R, Miedl, S, Maschke, M, Schröder, K, Aral Becher, B, Herzog Hauff, S, Guenther, A, Herzau, C, Hoffmann, U, Roth Zetzsche, S, Grond, M, Becker, M, Hamann, G, Simon, K, Köhrmann, M, Glahn, J, Wuttig, H, Nabavi, Dg, Seraphin, D, Schellong, S, Frommhold, R, Dichgans, M, Doerr, A, Blessing, E, Buss, I, Butter, C, Bettin, D, Grosch, B, Blank, E, Wong, L, Liu, R, Lee, S, Kong, S, Yu, C, So, E, Jakal, Á, Masszi, G, Czuriga, I, Kapocsi, J, Soós, E, Csiba, L, Fekete, K, Valikovics, A, Dioszeghy, P, Muskóczki, E, Csányi, A, Matoltsy, A, Yuval, R, Bornstein, N, Elimelech, R, Chajek Shaul, T, Bursztyn, M, Hayek, T, Hazbon, K, Gavish, D, Anat, N, Wexler, D, Azar, P, Mosseri, M, Tsirulnikov, E, Rozenman, Y, Logvinenko, S, Tanne, D, Don, A, Gross, B, Feldman, Y, Klainman, E, Genin Dmitrishin, I, Eldar, M, Eizenberg, N, Atar, S, Lasri, E, Hammerman, H, Aharoni, G, Zimlichman, R, Zuker, S, Telman, G, Afanasiev, S, Katz, A, Biton, A, Goldhaber, A, Goldhaber, M, Elian, D, Linor, A, Meyuhas, S, Tsalihin, D, Kissos, D, Lampl, Y, Israelson, M, Gottlieb, S, Dotan, L, Elis, A, Karny, M, Hussein, O, Shestatski, K, Brenner, H, Segal, E, Baldini, U, Gavazzi, A, Poloni, M, Censori, B, Aiazzi, L, Maraglino, C, Marenzi, G, Specchia, G, Tritto, I, Golino, P, Cianflone, Domenico, Martignoni, A, Tamburino, C, Rubartelli, P, Ardissino, D, Tadonio, I, Stramba Badiale, M, Cernuschi, P, Nardulli, R, Sommariva, L, Giordano, A, Berni, A, Cavallini, C, Fiscella, A, Azzarelli, S, Esposito, G, Cassese, S, Danzi, G, Fattore, L, Barbieri, E, De Caterina, R, Odero, A, Puttini, M, Corrada, E, Monzini, N, Vadalà, A, Pistarini, C, Scrutinio, D, Ferratini, M, Marcheselli, S, Moretti, L, Partemi, L, Pupilella, T, Lazzari, A, Ledda, A, Geraci, G, Rasura, M, Beccia, M, Cassadonte, F, Vatrano, M, Bongiorni, D, Mos, L, Marcuzzi, G, Murena, E, Uguccioni, L, Ferretti, C, Piti ATerrosu, P, Perrone, Pf, Marconi, R, Grasso, L, Severi, S, Evola, R, Russo, N, Agnelli, G, Paci, C, Carugo, S, Silvestri, O, Testa, R, and Novo, S.
Abstract: BACKGROUND:Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1.METHODS:We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage.RESULTS:At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P
Published: 2012

45. Clinical pregenetic screening for stroke monogenic diseases: Results from lombardia GENS registry

Author: Bersano, A, Markus, H, Quaglini, S, Arbustini, E, Lanfranconi, S, Micieli, G, Boncoraglio, G, Taroni, F, Gellera, C, Baratta, S, Penco, S, Mosca, L, Grasso, M, Carrera, P, Ferrari, M, Cereda, C, Grieco, G, Corti, S, Ronchi, D, Bassi, M, Obici, L, Parati, E, Pezzini, A, De Lodovici, M, Verrengia, E, Bono, G, Mazucchelli, F, Zarcone, D, Calloni, M, Perrone, P, Bordo, B, Colombo, A, Padovani, A, Cavallini, A, Beretta, S, Ferrarese, C, Motto, C, Agostoni, E, Molini, G, Sasanelli, F, Corato, M, Marcheselli, S, Sessa, M, Comi, G, Checcarelli, N, Guidotti, M, Uccellini, D, Capitani, E, Tancredi, L, Arnaboldi, M, Incorvaia, B, Tadeo, C, Fusi, L, Grampa, G, Merlini, G, Trobia, N, Braga, M, Vitali, P, Baron, P, Grond Ginsbach, C, Candelise, L, Candelise, L., FERRARI, MAURIZIO, FERRARESE, CARLO, CORATO, MANUEL, Bersano, A, Markus, H, Quaglini, S, Arbustini, E, Lanfranconi, S, Micieli, G, Boncoraglio, G, Taroni, F, Gellera, C, Baratta, S, Penco, S, Mosca, L, Grasso, M, Carrera, P, Ferrari, M, Cereda, C, Grieco, G, Corti, S, Ronchi, D, Bassi, M, Obici, L, Parati, E, Pezzini, A, De Lodovici, M, Verrengia, E, Bono, G, Mazucchelli, F, Zarcone, D, Calloni, M, Perrone, P, Bordo, B, Colombo, A, Padovani, A, Cavallini, A, Beretta, S, Ferrarese, C, Motto, C, Agostoni, E, Molini, G, Sasanelli, F, Corato, M, Marcheselli, S, Sessa, M, Comi, G, Checcarelli, N, Guidotti, M, Uccellini, D, Capitani, E, Tancredi, L, Arnaboldi, M, Incorvaia, B, Tadeo, C, Fusi, L, Grampa, G, Merlini, G, Trobia, N, Braga, M, Vitali, P, Baron, P, Grond Ginsbach, C, Candelise, L, Candelise, L., FERRARI, MAURIZIO, FERRARESE, CARLO, and CORATO, MANUEL
Abstract: Background and Purpose - Lombardia GENS is a multicentre prospective study aimed at diagnosing 5 single-gene disorders associated with stroke (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, MELAS [mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], hereditary cerebral amyloid angiopathy, and Marfan syndrome) by applying diagnostic algorithms specific for each clinically suspected disease Methods - We enrolled a consecutive series of patients with ischemic or hemorrhagic stroke or transient ischemic attack admitted in stroke units in the Lombardia region participating in the project. Patients were defined as probable when presenting with stroke or transient ischemic attack of unknown etiopathogenic causes, or in the presence of <3 conventional vascular risk factors or young age at onset, or positive familial history or of specific clinical features. Patients fulfilling diagnostic algorithms specific for each monogenic disease (suspected) were referred for genetic analysis. Results - In 209 patients (57.4±14.7 years), the application of the disease-specific algorithm identified 227 patients with possible monogenic disease. Genetic testing identified pathogenic mutations in 7% of these cases. Familial history of stroke was the only significant specific feature that distinguished mutated patients from nonmutated ones. The presence of cerebrovascular risk factors did not exclude a genetic disease. Conclusions - In patients prescreened using a clinical algorithm for monogenic disorders, we identified monogenic causes of events in 7% of patients in comparison to the 1% to 5% prevalence reported in previous series.
Published: 2016

46. Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults

Author: Pezzini, A., Grassi, M., Lodigiani, C., Patella, R., Gandolfo, C., Zini, A., Delodovici, M. L., Paciaroni, M., Del Sette, M., Toriello, A., Musolino, R., Calabrò, R. S., Bovi, P., Adami, A., Silvestrelli, G., Sessa, M., Cavallini, A., Marcheselli, S., Bonifati, D. M., Checcarelli, N., Tancredi, L., Chiti, A., Del Zotto, E., Spalloni, A., Giossi, A., Volonghi, I., Costa, P., Giacalone, G., Ferrazzi, P., Poli, L., Morotti, A., Rasura, M., Simone, A., M, ., Gamba, M., Cerrato, P., Micieli, G., Melis, M., Massucco, D., De Giuli, V., Iacoviello, L., Padovani, A., Italian Project on Stroke in Young Adults Investigators, and Balestrino, Maurizio
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, stroke, brain ischemia, prognosis, Brain Ischemia, Brain ischemia, Cohort Studies, Age Factors, Female, Follow-Up Studies, Humans, Italy, Predictive Value of Tests, Prospective Studies, Recurrence, Stroke, Young Adult, Physiology (medical), Internal medicine, medicine, Myocardial infarction, Young adult, Prospective cohort study, business.industry, medicine.disease, Migraine with aura, Confidence interval, Surgery, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract: Background— Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. Methods and Results— We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%–17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%–17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%–1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0- to 5-year score was 0.66 (95% confidence interval, 0.61–0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65). Conclusions— Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation.
Published: 2014

47. Ictus ischemico in età giovanile

Author: Pezzini, Alessandro, Grassi, M., Lodigiani, C., Patella, R., Gandolfo, C., Zini, A., Delodovici, M. L., paciaroni MD, M., Del Sette, M., Toriello, A., Musolino, R., Calabrò, R. S., Bovi, P., Adami, A., Silvestrelli, G., Sessa, M., Cavallini, A., Marcheselli, S., Bonifati, D. M., Checcarelli, N., Tancredi, L., Chiti, A., DEL ZOTTO, Elisabetta, Spalloni, A., Giossi, Alessia Alberica, Volonghi, Irene, Costa, Paolo, Giacalone, G., Ferrazzi, P., Poli, Loris, Morotti, Andrea, Rasura, M., Simone, A. M., Gamba, M., Cerrato, P., Micieli, G., Melis, M., Massucco, D., De Giuli MD, V., Iacoviello, L., and Padovani, Alessandro
Published: 2014

48. Endovascular treatment versus systemic thrombolysis for acute ischemic stroke: the effect of time to treatment on outcome in the SYNTHESIS Expansion trial

Author: Ciccone, A., Gatti, A., Dell'Acqua, M. L., Muscia, F., Zecca, B., Magoni, M., Longoni, M., Balestrino, Maurizio, Bono, G., Inzitari, D., Nucera, A., Falaschi, F, Marcheselli, S., and Paciaroni, M.
Published: 2014

49. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study

Author: Paciaroni, M, Inzitari, D, Agnelli, G, Caso, V, Balucani, C, Grotta, J, Sarraj, A, Sung Il, S, Chamorro, A, Urra, X, Leys, D, Henon, H, Cordonnier, C, Dequatre, N, Aguettaz, P, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Zini, A, Vallone, S, Dell'Acqua, M, Menetti, F, Nencini, P, Mangiafico, S, Barlinn, K, Kepplinger, J, Bodechtel, U, Gerber, J, Bovi, P, Cappellari, M, Linfante, I, Dabus, G, Marcheselli, S, Pezzini, A, Padovani, A, Alexandrov, A, Shahripour, R, Sessa, M, Giacalone, G, Silvestrelli, G, Lanari, A, Ciccone, A, De Vito, A, Azzini, C, Saletti, A, Fainardi, E, Orlandi, G, Chiti, A, Gialdini, G, Silvestrini, M, Ferrarese, C, Beretta, S, Tassi, R, Martini, G, Tsivgoulis, G, Vasdekis, S, Consoli, D, Baldi, A, D'Anna, S, Luda, E, Varbella, F, Galletti, G, Invernizzi, P, Donati, E, De Lodovici, M, Bono, G, Corea, F, Sette, M, Monaco, S, Riva, M, Tassinari, T, Scoditti, U, Toni, D, FERRARESE, CARLO, RIVA, MARTA, Toni, D., Paciaroni, M, Inzitari, D, Agnelli, G, Caso, V, Balucani, C, Grotta, J, Sarraj, A, Sung Il, S, Chamorro, A, Urra, X, Leys, D, Henon, H, Cordonnier, C, Dequatre, N, Aguettaz, P, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Zini, A, Vallone, S, Dell'Acqua, M, Menetti, F, Nencini, P, Mangiafico, S, Barlinn, K, Kepplinger, J, Bodechtel, U, Gerber, J, Bovi, P, Cappellari, M, Linfante, I, Dabus, G, Marcheselli, S, Pezzini, A, Padovani, A, Alexandrov, A, Shahripour, R, Sessa, M, Giacalone, G, Silvestrelli, G, Lanari, A, Ciccone, A, De Vito, A, Azzini, C, Saletti, A, Fainardi, E, Orlandi, G, Chiti, A, Gialdini, G, Silvestrini, M, Ferrarese, C, Beretta, S, Tassi, R, Martini, G, Tsivgoulis, G, Vasdekis, S, Consoli, D, Baldi, A, D'Anna, S, Luda, E, Varbella, F, Galletti, G, Invernizzi, P, Donati, E, De Lodovici, M, Bono, G, Corea, F, Sette, M, Monaco, S, Riva, M, Tassinari, T, Scoditti, U, Toni, D, FERRARESE, CARLO, RIVA, MARTA, and Toni, D.
Abstract: The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0–2) or unfavourable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88–1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40–0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5–6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86–1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those trea
Published: 2015

50. Endovascular Treatment for Acute Ischemic Stroke

Author: Ciccone, A, Valvassori, L, Nichelatti, M, Sgoifo, A, Ponzio, M, Sterzi, R, Boccardi, E, SYNTHESIS Expansion Investigators: Gatti, A, Guccione, A, Motto, C, Santilli, I, Tortorella, R, Ferrante, E, Imbesi, F, Marazzi, R, Jann, S, Protti, A, Rizzone, M, Tiraboschi, P, Pero, G, Quilici, L, Piano, M, Zini, A, Casoni, F, Cavazzuti, M, Falzone, F, Nichelli, P, Vallone, S, Carpeggiani, P, Menetti, F, Guidotti, M, Checcarelli, N, Muscia, F, Martegani, A, Torgano, G, Mandelli, C, Zecca, B, Baron, P, Bersano, A, Branca, V, Isalberti, M, Papa, R, Paolucci, A, Magoni, M, Costa, A, Gamba, M, Gasparotti, R, Federico, F, Petruzzellis, M, Tartaglione, B, Mezzapesa, D, Chiumarulo, L, De Blasi, R, Agostoni, E, Botto, E, Longoni, M, Ballarini, V, Reganati, P, Malfatto, L, Rizzi, D, Serrati, C, Balestrino, M, Gandolfo, C, Castellan, L, Mavilio, N, Allegretti, L, Delodovici, Ml, Carimati, F, Verrengia, Ep, Bono, G, Perlasca, F, Craparo, G, Giorgianni, A, Azzini, C, De Vito, A, Tola, M, Saletti, A, Pozzessere, C, Corsi, F, Scifoni, G, Anticoli, S, Pezzella, Fr, Cotroneo, E, Gigli, R, Nencini, P, Palumbo, V, Pantoni, L, Inzitari, D, Mangiafico, S, Chinaglia, M, Russo, M, L'Erario, R, Amistà, P, Malferrari, G, Nucera, A, Zedde, Ml, Dallari, A, Deberti, G, Falaschi, F, Martignoni, A, Zappoli, F, Marcheselli, S, Stival, B, Presbitero, P, Rossi, Ml, Belli, G, Paciaroni, M, Caso, V, Agnelli, Gc, Hamam, M, Bovi, P, Piovan, Enrico, Sessa, M, Scomazzoni, F, Arnaboldi, M, Tancredi, L, Peroni, R, Censori, B, Poloni, M, Lunghi, S, Bonaldi, G, Donati, E, Magni, E, Pavia, M, Cobelli, M, Bottacchi, E, Corso, G, Tosi, P, Cordera, S, Di Giovanni, M, Giardini, G, Meloni, T, Cristoferi, M, Natrella, M, Ruiz, L, Dell'Acqua, Ml, Rolandi, G, Gallesio, I, Sandercock, P, Candelise, L, del Zoppo, G, Ciceri, E, Doneda, P, Daolio, M, Caputo, D, del Zotto, E, Cantisani, T., Ciccone, A, Valvassori, L, Nichelatti, M, Sgoifo, M, Ponzio, M, Sterzi, R, Boccardi, E, and Comi, Giancarlo
Subjects: Adult, Male, OCCLUSION, Psychoanalysis, RECANALIZATION, Neuroimaging, Article, law.invention, Brain Ischemia, TISSUE-PLASMINOGEN-ACTIVATOR, Randomized controlled trial, Fibrinolytic Agents, law, Case fatality rate, medicine, Humans, Single-Blind Method, PROUROKINASE, cardiovascular diseases, Adverse effect, Infusions, Intravenous, Stroke, Aged, Cerebral Hemorrhage, Thrombectomy, business.industry, Standard treatment, Endovascular Procedures, TISSUE-PLASMINOGEN-ACTIVATOR, CEREBRAL-ARTERY STROKE, RANDOMIZED-TRIAL, INTRAARTERIAL THROMBOLYSIS, INTRAVENOUS THROMBOLYSIS, OCCLUSION, REVASCULARIZATION, RECANALIZATION, PROUROKINASE, THROMBECTOMY, Atrial fibrillation, General Medicine, Odds ratio, Middle Aged, medicine.disease, INTRAARTERIAL THROMBOLYSIS, Combined Modality Therapy, RANDOMIZED-TRIAL, Cerebral Angiography, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, Acute Disease, REVASCULARIZATION, Female, INTRAVENOUS THROMBOLYSIS, CEREBRAL-ARTERY STROKE, business, Fibrinolytic agent
Abstract: In patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed.We randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months.A total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P=0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate.The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).
Published: 2013

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